2011 Radiology Exam - Spec Proced/NM Case 2

History

• 2 year old, female spayed DSH
• This cat was diagnosed with a uroabdomen and was taken to surgery. No rents in the urinary system were found.
• The cat remains severely azotemic.

See images below. Click to enlarge.

Observation

Major findings

• Reduced serosal detail
• Pleural effusion
• Wispy soft tissue in the subcutaneous tissues
• Wispy soft tissue in the retroperitoneal space
• Inadequate bladder distension
• Normal vesicoureteral reflux

Minor findings

• Questionable to mild cardiomegaly
• Corrugated colon

Synthesis

• Uroabdomen is related to a leak in the urinary system
  • Bladder is inadequately distended to assess for a tear and more contrast should be given
  • EU and urethrogram could be considered to evaluated the remainder of the urinary tract
• Pleural fluid and subcutaneous fluid may be related to vasculitis and fluid overload
• Retroperitoneal fluid may be related to vasculitis, fluid overload, or ureteral tear

Case Management:

• Ask for additional radiographs with the bladder more distended
• Possible evaluation of the heart (echo)

Requested images

• An additional lateral was provided if the candidate clearly indicated they wanted to try to distend the bladder further
  • The bladder is still inadequately distended with irregular margins and questionable extravasation
  • Images were not provided if the candidate assumed the bladder was turgid and did not specifically request to proceed with the study
• A final set of radiographs (lateral and VD) were provided if the candidate requested to continue to distend the bladder

Challenges:

• Candidates often recognized that the bladder was inadequately distended but many candidates assumed that this was due to lack of distensability of the urinary bladder rather than a technical error and diagnosed the bladder as severely thickened.
• Many candidates also failed to put all the signs together in relation to fluid overload/vasculitis and only integrated the findings in the context of multiple trauma.