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.

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.