2008 Radiology Exam - Abdomen Case 1

"Waffle" -- 2 views of the abdomen

• 4 year old Cornish Rex castrated male
• vomiting hourly x 12 hours

See images below. Click to enlarge.

Radiographic findings:

• small intestinal plication and bunching from level of duodenum to colon
• linear soft tissue structures surrounded by air in ascending colon
• good serosal detail
• soft tissue medial to spleen, lateral to left kidney on VD view is most likely pancreas

Radiographic Diagnosis:

• small intestinal linear foreign body
• good serosal detail makes perforation less likely
• probably normal pancreas

Recommendations:

• Surgery
• US ok, to confirm FB and evaluate for free fluid, pancreatitis
• minus a point if barium Upper GI recommended, since the cat is vomiting profusely -- he will probably vomit up the contrast medium, putting the cat at risk for aspiration. Also, barium should be avoided if perforation is possible or surgery is likely.

Candidate Performance:
All candidates listed foreign body as a differential, but some mentioned IBD and neoplasia. Some recommended UGI.