2004 Radiology Exam - Ultrasound Case 2

Objective of the Case
The case was intended to test the candidate’s ability to recognize common abnormalities (specifically prostatic neoplasia) and evaluate associated abnormalities (hydronephrosis, metastasis).

Information provided to Candidate
Signalment:

  • Eight-year-old, castrated male Shetland sheepdog

History:

  • Difficulty urinating.
  • Treated twice for urinary tract infection

Patient and Probe Position:

  • Patient is in right lateral recumbency with probe on caudal left abdomen. Cranial is to the left.

Candidates were given written instructions to describe sonographic findings, to generate a list of differentials, and to be specific.

See images below. Click to enlarge.

Findings Expected from Candidate
The videoclip showed a mass in the urinary bladder (Image 1). The prostate was enlarged for a castrated male.

Conclusions Expected from Candidate
Candidates were expected to suspect prostatic neoplasia with metastasis to the medial iliac lymph node and to postulate dilation of the left renal pelvis to be occurring secondary to the neoplasm at the trigone of the urinary bladder. Candidates were expected to suggest transitional cell carcinoma and prostatic adenocarcinoma as likely neoplasms.

Summary of Overall Candidate Performance
The question was worth a total of 10 points. Candidates scored an average of 90%. Some candidates failed to adequately discuss the appearance and significance of the medial iliac lymph nodes. In general candidates recognized changes in the urinary bladder and prostate gland and suspected neoplasia.