2008 Radiology Exam - Abdomen Case 2

"Biscuit" -- 2 view abdomen

  • 3 year old Yorkshire Terrier spayed female
  • hit by bicycle

See images below. Click to enlarge.

Radiographic Findings:

  • loops of small intestine outside body wall in left ventral/inguinal region
  • no visible urinary bladder
  • increased soft tissue opacity in retroperitoneal space
  • right SI luxation
  • left iliac body, right ischial, and bilateral pubic fractures
  • wispy subcutaneous soft tissue in lumbar region

Radiographic Diagnoses:

  • body wall herniation with small intestine in left inguinal region
  • possible urine leakage or hemorrhage in retroperitoneal space
  • possible ruptured urinary bladder

Recommendations:

  • Excretory urography (once patient hydrated and stable) preferred over cystography, since we need to evalute kidneys and ureters
  • +/- ultrasound of abdomen to evaluate for free fluid, etc
  • surgery to repair hernia, fractures
  • complete thoracic radiographs

Candidate performance:
The retroperitoneal space and lack of urinary bladder visualization was missed by some candidates. The recommendation for excretory urography and why was not consistent.