2011 Radiology Exam - Spec Proced/NM Case 1

History

  • 2 year old, female spayed Labrador
  • This dog presents for lethargy, vomiting and anorexia of 2 days duration.
  • The abdomen is painful on palpation.

See images below. Click to enlarge.

Observation

Major findings

  • Non-obstructive, circumferential mural mass involving the descending duodenum with mucosal irregularity.
  • Wide gastroduodenal angle.
  • Reduced serosal detail in the right cranial abdomen.
  • Wispy soft tissue in the retroperitoneal space

Minor findings

  • Barium reflux into the esophagus on the 30 minute study
  • Corrugated jejunum.

Synthesis

  • Mural duodenal mass may be non-infectious inflammatory (ulcer, duodenitis) from external causes (pancreatitis, pancreatic neoplasia), infectious inflammatory (fungal) or neoplastic (adenocarcinoma).
  • Right cranial quadrant peritonitis from pancreatitis, pancreatic mass or inflammation from bowel mass.

Case Management:

  • Ultrasound to look for pancreatic involvement and perform aspirates of the mass and/or fluid.
  • Thoracic radiographs to assess for metastatic disease.

All candidates identified an abnormality of the duodenum. Many candidates failed to recognize that the lesion was mural and diagnosed a foreign body. Several candidates did not recognize that the right cranial quadrant was abnormal outside the duodenum and/or did not identify regional peritonitis. Unsuccessful candidates identified multiple lesions in the bowel leading to a diagnosis of infiltrative disease throughout the jejunum. Several candidates listed neoplasia as their only differential despite the signalment and history of the dog.