Radiology Packet 37

1. Radiology Packet 37 Urinary Contrast

2. 1 yr old MC Miniature Poodle“Poutchi” • HX = presented because he was hit by a car, one survery film was done followed by a urethrogram/cystogram

3. 1 yr old MC Miniature Poodle“Poutchi”

4. 1 yr old MC Miniature Poodle“Poutchi” • 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 Retriever“Homer” • HX = presented for bloody urine

6. 2 yr old MC Labrador Retriever“Homer”

7. 2 yr old MC Labrador Retriever“Homer”

8. 2 yr old MC Labrador Retriever“Homer”

9. 2 yr old MC Labrador Retriever“Homer” • 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

10. 8 yr old M GSD“Ben” • HX = presented with a history of dysuria and passing fresh blood at the end of urination, physical examination revealed prostatic enlargement

11. 8 yr old M GSD“Ben” • RF • This is a normal retrograde urethrogram, the prostate is visible and is within normal limits(<70% 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 Dalmatian“Max” • HX = history of stranguria and pollakiuria, after physical exam a urinary catheter was unable to be passed

13. 4 yr old M Dalmatian“Max”

14. 4 yr old M Dalmatian“Max” • 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 DSH“Marmalade” • No HX given

16. 3 yr old M DSH“Marmalade” • 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)

17. 7 yr old M DLH“Blackie” • HX = history of hematuria

18. 7 yr old M DLH“Blackie”

19. 7 yr old M DLH“Blackie”

20. 7 yr old M DLH“Blackie”

21. 7 yr old M DLH“Blackie” • 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 Dog“OC” • HX = dribbling urine since puppyhood, but she also urinates normally

23. 6 mo old F Mix Breed Dog“OC”

24. 6 mo old F Mix Breed Dog“OC”

25. 6 mo old F Mix Breed Dog“OC” • 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 DSH“Scooter” • 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 DSH“Scooter” • 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

28. 6 yr old MC DSH“Gus” • HX = long history of frequent urination and intermittent hematuria

29. 6 yr old MC DSH“Gus”

30. 6 yr old MC DSH“Gus” • 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 Shepherd“Princess” • HX = presented for evaluation of recurrent urinary tract infection and hematuria

32. 16 yr old FS German Shepherd“Princess”

33. 16 yr old FS German Shepherd“Princess” • 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

34. 6.5 yr old DSH • HX = history of weight loss and a somewhat tender abdomen

35. 6.5 yr old DSH

36. 6.5 yr old DSH

37. 6.5 yr old DSH

38. 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