It’s time for another round of KCC. Our residents stepped up and did a nice job of describing and analyzing the cases this week. If you are new to Veterinary Radiology, or want to improve your reporting skills, read this post on the format of a case report.
7 year old female neutered cat with anorexia and lethargy
On two whole body radiographs, there was pleural effusion, peritoneal effusion, and an enlarged left kidney with a slightly irregular border. The right kidney was not visible. Differential diagnoses included lymphoma, FIP, and hydronephrosis with fluid overload. Possible additional tests would be abdominal ultrasound to look for obstructive renal disease. One comment was that a nephropyelogram would be better to look for a ureterolith than an excretory urogram. But the overwhelming top two differentials for bicavitary effusion in a cat are lymphoma and FIP. Both can present with unilateral renal involvement. This cat was older than a typical FIP case, but it depends when disease exposure occurred. Diagnosis: FIP.
9 year old Golden Retriever with bloody discharge from prepuce and anorexia.
The left kidney was enlarged and very poorly defined. It was difficult to recognize as more than a mass effect in the left retroperitoneal space, but displaced the descending colon medially and ventrally (classic left kidney enlargement!). The right kidney was normal and clearly visible. Radiographic diagnosis was left renomegaly with retroperitoneal effusion (poor visibility of the kidney). Differentials included renal abscess, pyelonephritis, renal neoplasia and hydronephrosis. The effusion could have been edema, inflammatory or hemorrhage. Next steps could include abdominal ultrasound to differentiate between the above causes and obtain samples. Diagnosis: Renal abscess.
10 year old terrier with coughing and retching.
A lateral radiograph of the neck was normal. The thoracic esophagus contained some air and a faint mineral opacity. There was alveolar pattern in the right middle lung lobe and pleural effusion. On the d/v projection, the caudal reflection of the mediastinum appeared widened. The radiographic diagnosis was esophageal foreign body with possible perforation through the mediastinum into the pleural space. Next step: a non-ionic iodinated contrast esophagram showed leakage from the caudal esophagus into the mediastinum and pleural space. Diagnosis: Perforating esophageal foreign body with mediastinitis and plueritis, and aspiration pneumonia. Note that you should use non-ionic contrast when perforation is suspected. Barium will cause severe mediastinitis.
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