2013 Radiology Exam - Abdomen Case 2

Signalment: 4 year old female/s domestic short hair cat
History: chronic vomiting, lethargy
Radiographs: Right lateral and ventrodorsal views of the abdomen

Observation:
1. Major: Multiple foci of uncontained gas in the peritoneal space
2. Major: Numerous segments of small intestine with irregularly marginated intraluminal gas patterns outlining the small intestinal mucosa.
3. Major: Moderate gas dilation of these small intestinal loops
4. Minor: Loss of serosal detail in the mid-abdomen

Synthesis:
1. Major: Infiltrative bowel disease: Diffuse neoplasia versus inflammatory/infectious
2. Major: Secondary bowel perforation and peritonitis
3. Minor: Discussion of bowel dilation - distal mechanical obstruction versus functional ileus

Management:
1. Major: Surgery
2. Minor: Thoracic radiographs
3. Minor: Biopsy

Case comments:
In general, most candidates scored well on this case. The majority of candidates recognized the free peritoneal gas and some felt obliged to request horizontal beam radiographs, though this was not considered in the scoring. Many candidates did not discuss the significance of the intestinal dilation and lost serosal detail in the context of the other observations. Most point deductions were for errors or omissions in the management section of the case. Many candidates surprisingly concluded that intestinal perforation and peritonitis were present but failed to recommend surgery. And a surprising number of candidates failed to recommend biopsy as necessary for final diagnosis. Candidates recommending abdominal ultrasound with justification such as provision of additional information to owners to guide their treatment decision were not penalized, but those candidates recommending ultrasound examination without justification lost credit.