Pure heaven…sleepy puppy on the table…

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Courtesy of Julien Fages

Join us at the next Imaging Summer Camp !

Dominique and I have been invited to speak at the next Imaging Summer Camp taking place in Lanzarote on May 20-24, 2019. We’re super excited and hope to meet some of you there! For more information on that meeting, visit VetMeet.

Here is the answer…

Here is the annotated video clip of the 13 year old miniature poodle.

Thank you for your comments !

The pedunculated lesions (at least 2) were located in the antrum of the stomach.  The dog was rotated to the right, in order to move the existing fluid in the stomach toward the pyloro-duodenal junction.  As you can see during peristaltic activity, the nodules “float” and move back and forth…possibly mimicking an intussusception.  The lesions are moderately echogenic and partially layered, and seem bordered by a hyperechoic wavy mucosal line.  When asked after the ultrasound findings, the owner mentioned a recent episode of vomiting of undigested food.

Endoscopic biopsies were taken and the diagnosis was gastric inflammatory polyps with concurrent marked diffuse mucosal hyperplasia and moderate chronic neutrophilic and lymphohistiocytic gastritis (myriad of bacteria).

These lesions can be quite spectacular but not uncommon in miniature breeds.  In absence of clinical signs, follow-up ultrasound may be recommended.

Time to play!

13-year-old toy Poodle is presented for a routine blood glucose curve and a neurological evaluation for ataxia.

What do you think about the video clip of his stomach?

Notice the patient’s position…how is it impacting your findings?

I cannot wait to read your replies and I will give you my thoughts in a couple of days.

What about Coco?

To see the original post, click here.

The duodenostomy site shows expected focal thickening, with numerous hyperechoic foci representing suture material.  The local fat is hyperechoic which is expected for a one week post-operative recheck.  There was no abnormal fluid collection near the anastomosis site.

See below a longitudinal image of the duodenostomy, between the shadows of 2 ribs, and a transverse image with numerous sutures seen best in the near wall:

But the incision of the abdominal wall appears like this:

inc 2

An elongated fluid pocket dissecting the subcutaneous tissues, and likely representing an infected seroma.

The dog was sent back to surgery for debridement of the infected incision.  The abdominal cavity was lavaged as it was suspected to be contaminated, but the duodenostomy site was confirmed to be intact.

The dog recovered uneventfully.

Time to play…

One week ago, Coco, a 3 year old mixed dog breed, had surgery for a foreign body at a referral clinic.  He was doing well but now his appetite has decreased and he is a bit lethargic.   An ultrasound was performed to rule out dehiscence…what do you think?

To read the answer, click here.

And the answer for Blackie is…

Thank you all for your comments on this case!

Blackie was sent to surgery as the ultrasound showed a stick perforating the fundus of the stomach, and most of the stick was embedded in the adjacent omentum.  The inhomogeneous appearance of the omentum supports regional inflammation/infection. The omentum successfully sealed off the foreign body, which explains why the dog did not display any gastrointestinal signs.  The process was likely chronic.

Right after surgery, the heart rate returned to normal!

Please review the annotated video below:

 

Time to play!

Blackie, a 15-year-old cat was presented for severe bradyarrhythmia. An abdominal ultrasound was performed as part of the work-up for systemic disease that could cause 3d degree AV block. On blood work, there is a slight leukocytosis.  See a short video clip of the left side of the abdomen.  What is your diagnosis?  Recommendations?

and the answer is…

The video clip started by the bladder (on the left side of the abdomen as the dog is slightly rotated) that was normal.
Even for an intact male, the prostate is enlarged, highly echogenic, inhomogeneous with numerous variable size cysts. The prostate appears irregular in contour, this is especially obvious on the transverse plane. The urethra is a poorly echogenic structure barely distinguished in the prostate; an indwelling urinary catheter would help in better visualizing the urethra (if an intervention is planned). The appearance of the prostate support benign cystic hyperplasia. A concurrent prostatitis is possible.
When the operator is scanning the right caudal abdomen, a large cavitary structure (resembling the bladder)with a thin wall is seen, it contains echogenic sediment that is gravity dependent.
At the end of the clip, this fluid filled cystic structure appears to originate from the right side of the prostate; this is a paraprostatic cyst.

Initially, the dog has been placed on antibiotics by the referral veterinarian and responded well to the treatment as his clinical signs resolved. What to do next is often multifactorial. Your responses on management varied and are all good suggestions. Our choice was to recommend surgery to neuter the dog and marsupialize the large paraprostatic cyst. The option of performing a fine-needle aspirate of the paraprostatic cyst is reasonable but the wall being thin, there may be a higher chance for leakage. Additionally, the outcome of the FNA would not really affect the need for surgery.

The dog recovered uneventfully after surgery.

Thank you for sending your opinions!

Time to play again!

Lets start 2018 with the exam performed on Frankie, a 4-year-old male Pit Bull presented for straining to urinate and defecate. He was given 2 weeks of Baytril and his clinical signs resolved. He was scheduled for an internal medicine consultation and an ultrasound was performed. What is the likely diagnosis? What would you recommend?
Send along your thoughts!