2012 Radiology Exam - Abdomen Case 1

History

  • 8 year old male/c Springer Spaniel
  • Panting, inappetence, weight loss

Imaging Study

  • Right lateral and ventrodorsal views of the cranial and caudal abdomen

Observations

  • Prostate occupies approximately 50% of the sacropubic diameter
  • Prostate margins are irregular
  • Amorphous mineral opacities are present within the prostatic parenchyma
  • Left kidney is enlarged with loss of normal shape
  • Left kidney contains linear mineral opacities roughly conforming to the shape of the renal pelvis
  • Mixed bronchial, unstructured interstitial, and structured interstitial pulmonary infiltrates are present within the caudal portion of the lung included in the study.

Synthesis

  • Presence of a prostate of moderate size and irregular margination containing amorphous mineralization in a castrated male dog
  • Finding most consistent with prostatic neoplasia with primary rule outs of adenocarcinoma or transitional cell carcinoma
  • Enlarged left kidney with altered shape and internal mineralization.
  • Ddx:
    • hydronephrosis related to obstruction at the level of the urinary trigone secondary to neoplastic invasion
    • metastasis of prostatic neoplasm
  • Mixed pulmonary pattern including pulmonary nodules/masses consistent with metastasis of prostatic neoplasm

Case Management

  • Abdominal ultrasound examination for examination and tissue sampling of the prostate and left kidney and for evaluation of regional lymph  nodes
  • Thoracic radiographs to confirm suspected diagnosis of pulmonary metastasis

Challenges

  • Failure to recognize that prostate size is abnormal in castrated male dog
  • Failure to observe or ascribe appropriate significance to the mineral opacity in the prostate
  • Failure to attempt to link left kidney abnormalities to the prostatic neoplasm.  On post mortem in this animal, the left kidney was both hydronephrotic and significantly replaced by neoplastic metastasis
  • Failure to adequately evaluate or attach appropirate significance to pulmonary pattern
  • Failure to completely evaluate the radiographic study.  Several candidates missed the primary diagnosis due to failure to evaluate the caudal abdomen in this 4 view radiographic study