2013 Radiology Exam - Spec Proced/NM Case 1

HISTORY: 3 year old male neutered Domestic Shorthair Cat. Chronic urinary tract infections.

IMAGING STUDIES: Positive Contrast and Double Contrast Cystogram.

Positive Contrast Cystogram

  • Thickening of the cranial and ventral urinary bladder wall with irregular cyst-like structure extending into the thickened wall at the vertex
  • Reflux of contrast into the right kidney with mild dilation of the renal pelvis

Double Contrast Cystogram

  • Marked thickening of the vertex of the bladder with retention of positive contrast on irregular mucosa.
  • Retention of positive contrast in cyst-like lesion in the wall of the bladder

SYNTHESIS

  • Urachal remnant/diverticulum
  • Chronic cystitis

CASE MANAGEMENT

  • Surgery
  • Culture (may be affected by contrast medium)
  • Cystoscopy

CHALLENGES

  • This case was handled well by most candidates with a good overall score.
  • Reflux of contrast into the right ureter and right renal pelvis secondary to the cystogram was frequently interpreted as occurring from a previous excretory urogram despite clearly labeled images and lack of contrast in the renal parenchyma, and lack of visualization of the left kidney.
  • Reflux was also frequently interpreted as abnormal due to pyelonephritis or reabsorption of contrast systemically.
  • The thickened bladder wall was occasionally not seen and not interpreted as cystitis
  • Management did not always address the primary and secondary problems.