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.