2010 Radiology Exam - Ultrasound Case 1

History:

  • 6-year old female Border collie
  • Presents for lethargy and a tense abdomen

Candidates were presented with a video clip that started in the left mid abdomen and moved caudally.

If you'd like to enlarge the video, use the 'ENTER FULL SCREEN' button on the playbar and the 'VIEW ACTUAL SIZE/VIEW FULL SIZE' button on the playbar of the full screen view to toggle scaling as needed.

Observations:

  • Multiple (at least 2) viable feti with detectable heart beats.
  • Adequate vesicular fluid.
  • Hyperechoic thickened portion of uterus present at the cranial aspect of the left uterine horn with no luminal fluid or fetal tissues.

Synthesis:

  • Normal viable pregnancy in second trimester.
  • Single resorption site.

Management:

  • Finish the ultrasound examination to assess for other causes of clinical signs.
  • Follow-up ultrasound in 2 weeks to evaluate for additional fetal loss or evidence of distress.
  • CBC, serum biochemistry to look for other causes of clinical signs.
  • Successful candidates were not penalized for recommending radiographs at 45 days gestation to count fetal numbers. However, a recommendation of radiographs at the current stage of pregnancy did not receive credit. Successful candidates described the resorption site as a potentially normal occurrence in dogs and did not assign undue significance to its presence.
  • Unsuccessful candidates failed to describe the resorption site or identified it as an ovary. Others concluded it was a focal pyometra. A few candidates recommended aspiration of fluid from the uterus to rule out pyometra. Many unsuccessful candidates were unable to identify which trimester the pregnancy was in.
  • Overall, candidates did poorly on this question, the majority of which scored 5-7 out of 10 points.