Happy New Year to all the readers of Veterinary Radiology! We have a new look for the new decade, so I hope you like it. Here’s our first case of the year. It’s a 14 year old Terrier with diabetes, who is now vomiting. Take a look and post your interpretation in the comments section.
{ 7 comments… read them below or add one }
Three wire-shaped metallic opacities are seen seemingly within the intestinal tract, which probably are digested suture material. There seems to be no related intestinal obstruction.
On the lateral view, there is a dilated bowel loop in the cranioventral abdomen. The content has the radiopacity lower than that of soft tissue which is making the intestinal wall discernible. The remainder of the bowel loops is mostly gas filled and shows no intestinal dilation. Intraperitoneal and retroperitoneal detail is preserved.
Intestinal obstruction by a foreign body should be included in the differential diagnosis.
To further evaluate the gastrointestinal tract and duodenum in particular, it is advisable to do a contrast study or an abdominal ultrasound with more focus on the anatomical location of the duodenum.
Rounded opacity ventral to T8 on the lateral view, may represent pulmonary nodule. Rule out primary vs metastatic neoplasia.
Gas lucencies in the bladder, consistent with emphysematous cystitis, common in diabetic dogs.
Incidental foreign material in the GI tract.
Recommendations: thoracic radiographs, urine culture (aerobic and anaerobic).
The stomach and pylorus contain a moderate amount of fluid – Consideration is given to the patients h/o vomiting (r/o functional ileus vs **mechanical ileus. ~2cm, smoothly marginated soft tissue opacity is noted just causal to the stomach and cranial to the kidney on the lateral view (r/o neoplasia, granuloma/abscess with organ of origin being stomach, adrenal, kidney or pancreas)- neoplasia with partial outflow obstruction is considered most likely. Gastric FB ingestion with perf can’t be excluded (ie. Pica secondary to DM). Other loops of bowel are normal for size/shape. Free peritoneal gas is seen in the left and right cranial abdominal quadrants on the vd view, cranial to the liver and superimposed over the bladder on the lateral view (r/o recent abdominal sx or perforation of gastric ulcer/mass or other bowel). The metallic opacities are most consistent with previous OHE. The smooth soft tissure opacity ventral to T8 is most likely artifact from the collar
Rec: L lat and L lat horizontal beam to confirm free gas, if positive rec met check and explore, can also consider abd u/s
…GI series is contraindicated
Good job on the interpretations! A couple of you picked up on a soft tissue opacity in the lungs – this dog did have a pulmonary nodule but I didn’t include the thoracic radiographs. Nice pickup.
The history is vomiting, so we all hone in on the GI tract. In this case it is uniform in size and not enlarged. The opacity caudal to the stomach is the right kidney. I agree there is gas superimposed on the bladder, but is it necessarily of GI orgin? I don’t see free gas on the v/d (you should be able to see a very thin line representing the diaphragm). So what else can cause vomiting?
Eastcoastrad nailed it. Don’t forget about other causes of systemic disease… In this case I can’t follow any bowel loops from the gas over the bladder. We commonly see bowel loops superimposed on the bladder but you should be able to follow their course.
Answers are available, click on the case link.
HMMM, the 14 year old terrier seems like a pancreatic tumour, cos diabetes and vomiing fits, Lesion caudal to the gastro duo junction?
Im just a kid that want sto become a vet but i think this dog has sometyoe of worm. It looks like long tube thing(worm).
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