2010 Radiology Exam - Ultrasound Case 2

History:
14 year-old male castrated Italian greyhound
Presents for melena and decreased appetite
Physical exam indicates pale mucous membranes

Candidates were presented with a video clip that started in the cranial abdomen and moved caudally in to the mid-abdominal region.

Observations:

• Possible mottled liver.
• Focal small bowel loop with circumferential thickening of the wall and loss of normal wall layering.
• Remainder of the small bowel has normal thickness and layering.

Synthesis:

• Differentials for liver lesions include regenerative nodules, focal fibrosis, vacuolar or other hepatopathy. Candidates were not penalized for calling the liver normal as the findings were subtle and a wide range of ‘normal’ must be accounted for.
• Differentials for the bowel lesion include neoplasia (adenocarcinoma, mast cell tumor, lymphoma), granulomatous infiltration or severe ulceration.

Management:

• Aspirate bowel mass and/or liver.
• Thoracic radiographs to assess for metastatic disease.
• Surgical resection and biopsy.

Successful candidates were not penalized for including small intestinal leiomyosarcoma as a potential tumor type.

Unsuccessful candidates identified the affected intestinal segment as definitely the duodenum, diagnosed intestinal obstruction, or diagnosed intestinal perforation. Some candidates did not list neoplasia as one of the differential diagnoses for the small bowel lesion.

Overall, candidates did well on this question, the majority of which scored 7-9 out of 10 points.