Radiology Packet 37

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Radiology Packet 37

• Urinary Contrast

2
1 yr old MC Miniature PoodlePoutchi

• HX presented because he was hit by a car, one
  survery film was done followed by a
  urethrogram/cystogram

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1 yr old MC Miniature PoodlePoutchi
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1 yr old MC Miniature PoodlePoutchi

• RF
• There is reduced abdominal detail on the survey
  radiograph, questionable retroperitoneal detail
  and the urinary bladder cannot be visualized.
• There are multiple pelvic fractures including the
  shaft of one ilium and the pelvic floor.
• On the urethrogram the urinary catheter has been
  advanced into the mid-portion of the penile
  urethra.
• The urinary bladder has filled to some degree,
  there is a massive amount of contrast material
  within the peritoneal and retroperitoneal space.
• Note the kidneys are filtering the contrast and
  the renal pelvis and ureters are seen.
• The filling of the urinary bladder indicates that
  at least one ureter is reaching the bladder.
• RD
• Avulsion of the prostatic urethra from the
  urinary bladder secondary to severe pelvic
  trauma, including fractures.

5
2 yr old MC Labrador RetrieverHomer

• HX presented for bloody urine

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2 yr old MC Labrador RetrieverHomer
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2 yr old MC Labrador RetrieverHomer
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2 yr old MC Labrador RetrieverHomer
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2 yr old MC Labrador RetrieverHomer

• RF
• On the survey radiographs there is markedly
  reduced retroperitoneal space detail.
• The kidneys are not visualized at all and the
  colon is displaced ventrally.
• The urinary bladder is not well seen.
• On the excretory urogram films both kidneys and
  ureters are intact.
• The right renal pelvis and diverticula are
  dilated, the left is normal.
• A large filling defect within the urinary
  bladder, occupying the trigonal region, is
  positioned to the right.
• RD
• Retroperitoneal fluid or mass
• Intact urinary system
• Large space occupying mass eccentrically located
  to the right within the trigone causing right
  hydronephrosis

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8 yr old M GSDBen

• HX presented with a history of dysuria and
  passing fresh blood at the end of urination,
  physical examination revealed prostatic
  enlargement

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8 yr old M GSDBen

• RF
• This is a normal retrograde urethrogram, the
  prostate is visible and is within normal
  limits(lt70 of sacro-pubic distance).
• The prostatic urtehra is relatively wide, slight
  narrowing of the urethra is seen proximal and
  distal to the ischial arch and the urethra is
  wide as it curves around the arch.
• The unusual appearance of the contrast as it
  enters the bladder is the result of contrast
  entering under pressure.

12
4 yr old M DalmatianMax

• HX history of stranguria and pollakiuria, after
  physical exam a urinary catheter was unable to be
  passed

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4 yr old M DalmatianMax
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4 yr old M DalmatianMax

• RF
• In the film with the legs in neutral position
  multiple filling defects within the central
  contrast pool in the bladder.
• Three filling defects are present in the urethra
  at the proximal end of the os penis.
• Filling of the urethra with contrast is good in
  the prostatic region but poor in the perineal
  region.
• A round filling defect visible at the end of the
  urethral catheter is thought to be an air-bubble.
• In the films with the legs pulled cranially the
  three filling defects at the proximal end o f the
  os penis are more clearly seen.
• Due to an increasing volume of contrast material
  there is better distension of the perineal
  urethra, it is normal in appearance.
• RD
• Cystic calculi
• Urethral calculi
• Next
• Surgery

15
3 yr old M DSHMarmalade

• No HX given

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3 yr old M DSHMarmalade

• RF
• A retrograde urethrogram was performed and
  positive contrast material fills the urethra and
  enters the bladder which is moderately distended.
• Several distinct filling defects are present in
  the prostatic urethra just caudal to the bladder
  neck.
• The contrast material in the remainder of the
  prostatic urethra is indistinct (stippled) in
  appearance.
• A round gas bubble is visible within the center
  of the bladder.
• The linear structure of gas lucency in the
  cranial bladder is a superimposed gas-filled
  bowel segment.
• RD
• Urethral calculi
• Feline Lower Urinary Tract Disease (FLUTD)

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7 yr old M DLHBlackie

• HX history of hematuria

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7 yr old M DLHBlackie
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7 yr old M DLHBlackie
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7 yr old M DLHBlackie
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7 yr old M DLHBlackie

• RF
• On the double contrast cystogram there is no
  contrast adherence to the mucosa of the apical
  portion of the bladder.
• The renal diverticula have filled with contrast,
  they are normal and seen as fine, detailed linear
  tubular structures.
• The immediate films(2 films on 1 slide) nicely
  show the nephrogram phase of the excretory
  urogram, the kidneys show a homogenous blush.
• The urinary bladder and urethra have been filled
  with air prior to the IVP.
• The pyelogram portion of the IVP demonstrates
  pelves and ureters.
• The urinary bladder wall is noted to be mildly
  thickened, as the wall is followed from the
  trigone to the apex it becomes thicker, approx. 5
  mm thick.
• RD
• Mild cystitis

22
6 mo old F Mix Breed DogOC

• HX dribbling urine since puppyhood, but she
  also urinates normally

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6 mo old F Mix Breed DogOC
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6 mo old F Mix Breed DogOC
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6 mo old F Mix Breed DogOC

• RF
• Markedly dilated left ureter, the left renal
  pelvis is also dilated.
• The left ureter can be seen to enter the trigonal
  region in a normal location, then tunnels along
  the left side of the trigone, into the proximal
  urethra.
• Note that the urethra fills with contrast , an
  abnormal finding.
• The urinary bladder fills with contrast.
• A mild lateral cortical depression is noted in
  the left kidney.
• The right ureter and kidney are normal.
• RD
• Ectopic left ureter
• Left hydroureter/nephrosis which is secondary to
  chronic irritation, ascending infection

26
M DSHScooter

• HX the top film was obtained prior to a
  perineal urethrostomy, the bottom film was
  obtained because the patient presented with signs
  of urinary tract obstruction

27
M DSHScooter

• RF
• In the initial film the kidneys are visible and
  appear approximately normal size.
• The urinary bladder contains a single 2 mm round
  mineral opacity structure.
• There is a granular appearance to the ventral
  aspect of the bladder suggesting that mineralized
  sediment is present.
• Irregular mineral opacity material is present in
  the pelvic and proximal penile urethra.
• In the second film there are multiple
  variably-sized mineral opacity structures within
  the bladder and extending into the bladder neck.
• The bladder neck appears elongated.
• A gas bubble is also present within the bladder
  lumen.
• RD
• On the initial film, cystic calculus with
  evidence of mineralized bladder sediment and
  mineralized sediment/small calculi within the
  urethra
• On the second film, multiple cystic calculi

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6 yr old MC DSHGus

• HX long history of frequent urination and
  intermittent hematuria

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6 yr old MC DSHGus
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6 yr old MC DSHGus

• RF
• The bladder wall is markedly thickened and there
  is irregular mucoas present.
• The first positive contrast cystogram shows large
  filling defects within the lumen.
• The second film was taken following maximum
  distension of the urinary bladder, note how thick
  the bladder wall is.
• Excellent filling of the urethra was achieved, in
  fact the urethra is quite large for a male cat
  and may be dilated due to chronic irritation.
• RD
• Severe cystitis
• Next
• Surgical curettage of the bladder mucosa

31
16 yr old FS German ShepherdPrincess

• HX presented for evaluation of recurrent
  urinary tract infection and hematuria

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16 yr old FS German ShepherdPrincess
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16 yr old FS German ShepherdPrincess

• RF
• On the negative contrast cystogram the apical
  portion of the bladder wall is thickened,
  particularly the ventral bladder wall.
• The mucosal surface in the area of wall
  thickening is irregular.
• The gas outlines a triangular extension of the
  bladder lumen in the apical region.
• The faintly seen linear structure in the bladder
  lumen is a catheter.
• On the double contrast cystogram a small amount
  of contrast is seen adherent to the bladder
  mucosa in the apical region.
• The triangular exentsion of the bladder lumen in
  the apical region is unchanged in appearance.
• The catheter is now easily seen since it contains
  radiopaque contrast.
• RD
• Chronic cystitis

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6.5 yr old DSH

• HX history of weight loss and a somewhat tender
  abdomen

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6.5 yr old DSH
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6.5 yr old DSH
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6.5 yr old DSH
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6.5 yr old DSH

• RF
• On the survey radiographs the left kidney is of
  normal size, the right kidney is small.
• A round focus of mineral opacity is seen in the
  left cranio-dorsal abdomen approximately at the
  level of L3.
• Careful evaluation of this structure reveals that
  it is not in the GI tract.
• In the lateral view a tiny linear soft tissue
  structure is seen cranial to the object.
• A similar mineral opacity object is present in
  the bladder.
• On the IVU radiographs both kidneys opacify
  indicating both are functional.
• There is dilation of the collecting system and
  proximal ureter on the left.
• The ureteral distension ends at the mineral
  opacity that was previously described.
• The mineral opacity structure in the bladder is
  barely visible.
• RD
• Ureteral calculi
• Cystic calculi
• Hydronephrosis and hydroureter of the left kidney
  secondary to ureteral obstruction