Transcript Radiology Packet 30

Radiology Packet 30
Liver/Spleen
13 yr old F Collie/Lab
“Laurie”
• HX =
presented
for collapse,
she is weak
and pale on
examination
and an
abdominal
mass may
be present
on palpation
13 yr old F Collie/Lab
“Laurie”
13 yr old F Collie/Lab
“Laurie”
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RF
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RD
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On the lateral view there is a round soft tissue mass in the mid-ventral abdomen which is
obliterating the normal splenic shadow.
Serosal detail in this area is decreased and also the liver margin is rounded but not enlarged.
On the VD view the round mass is located in the cranial and central abdomen and it is
pushing the transverse colon cranially,
Splenic mass
Next
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Abdominal ultrasound
Surgical removal of the spleen
16 yr old FS DSH
“Bonnie Louise”
• HX = presented with icterus and a history of chronic
renal disease
16 yr old FS DSH
“Bonnie Louise”
16 yr old FS DSH
“Bonnie Louise”
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RF
– The liver is large, extending beyond the costal arch with a rounded caudal
border.
– Three small, roughly marginated mineralized opacities are present overlying the
liver, in the region of the gall bladder and bile duct.
– Both kidneys are small, a bit irregular, and have lost the characteristic shape.
– Mild spondylosis and sites of IV disc space collapse.
– Malalignment of S3-C1
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RD
– Cholelithiasis
– Hepatomegaly
– Small kidneys (consistent with history of chronic renal disease)
13 yr old F Miniature Poodle
“Velvet”
• HX = presented for evaluation of a palpable abdominal
mass
13 yr old F Miniature Poodle
“Velvet”
13 yr old F Miniature Poodle
“Velvet”
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RF
– The tail of the spleen is visible in the cranioventral abdomen and it appears to
connect to the large centrally located mass.
– The liver is of normal size.
– The urinary bladder is small, it is visible in the caudal abdominal cavity.
– The structures of the GI tract are displaced by the mass but are otherwise
normal in appearance.
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RD
– Large abdominal mass, splenic in origin
•
Next
– Metastasis check
– Biopsy
– Surgical Removal
3 yr old M Yorkshire Terrier
• HX = referred with a
history of recurrent
urethral obstruction
and reported to have
frequent episodes of
lethargy and
episodes of staring
into space
3 yr old M Yorkshire Terrier
3 yr old M Yorkshire Terrier
3 yr old M Yorkshire Terrier
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RF
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In one lateral view the gastric axis is displaced very far cranially indicating that the liver is
tiny.
The portion of the spleen that is visible appears normal.
They kidneys are best seen in the lateral view and appear approximately normal size.
Two fairly large, round mineral opacity structures are present in the bladder as well as some
less defined mineral material.
Abdominal detail is less than normal but this is a result of lack of abdominal fat (the animal is
very thin).
RD
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Microhepatia
Cystic calculi
The radiographic findings and clinical signs lead to a single disease process: portosystemic
shunt
12 yr old MC Manx cat
“Merlin”
• HX = presented for lethargy and partial anorexia, his
abdomen is tense on palpation
12 yr old MC Manx cat
“Merlin”
12 yr old MC Manx cat
“Merlin”
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RF
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RD
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Large soft tissue mass, mid-ventral abdomen on the lateral view, right of midline on VD view.
The head of the spleen is large.
There is decreased abdominal detail and the liver is large with rounded margins.
The left kidney is irregular in shape.
Large intra-abdominal mass which may be entirely splenic in origin
Enlarged liver
Mild amount of abdominal fluid
Next
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Abdominocentesis
Abdominal ultrasound and fine needle aspirate/biopsy of mass
Abdominal exploratory
11 yr old MC Mixed breed dog
“Pal”
• HX = presented for evaluation of increasing abdominal
size and respiratory difficulty for the last 7 days, a grade
3/6 heart murmur is ausculted
11 yr old MC Mixed breed dog
“Pal”
11 yr old MC Mixed breed dog
“Pal”
11 yr old MC Mixed breed dog
“Pal”
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RF
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Evaluation of the cardiac silhouette is hindered by the presence of free pleural fluid.
There is a generalized increase in pulmonary tissue opacity due to superimposition of free
fluid.
An air bronchogram is visible overlying the cranial cardiac margin in the lateral view and
there is a mild increase in opacity of the left cranial lung lobe noted in the VD.
There is increased opacity in the cranial abdominal cavity which is caused by the presence of
a mass lesion and the presence of free fluid leading to a loss of abdominal detail.
The tail of the spleen is visible but it appears large and has rounded indistinct borders.
The head of the spleen is not visible in the VD view, instead a rounded structure of soft tissue
opacity is visible caudal to the stomach.
The stomach contains several mineral opacity structures(stones).
RD
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Free pleural fluid and possible consolidation of the left cranial lung lobe
Cranioventral abdominal mass, most likely of splenic origin
Free abdominal fluid
6 yr old F Abyssinian
“Honey Bun”
• HX = history of episodic vomiting and now anorexia
6 yr old F Abyssinian
“Honey Bun”
6 yr old F Abyssinian
“Honey Bun”
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RF
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RD
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There is a discrete mineral opacity, irregular, noted over the liver within the region of the gall
bladder.
Two discrete, smaller foci of mineralization are noted on the lateral view along the rib margin,
along the cranial edge of the stomach.
The stomach is empty.
The SI has some gas in it, some of it almost looks “String of Pearls.”
A large amount of intra-abdominal fat is present.
Note the large amount of sternal fat around the heart.
Gall stones
Next
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Surgical removal
11 yr old MC West Highland Terrier
“Sam”
• HX = the dog is presented for evaluation of
splenomegaly and peripheral lymph node enlargement
11 yr old MC West Highland Terrier
“Sam”
11 yr old MC West Highland Terrier
“Sam”
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RF
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RD
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The liver is enlarged and the margins are rounded.
The head and tail of the spleen are visible and enlarged.
In the VD view an ovoid structure of soft tissue opacity is seen at the cranial margin of the left
kidney and superimposed with the stomach.
The urinary bladder is small but visible in the caudal abdominal cavity.
Generalized hepatomegaly
Generalized splenomegaly
Mass in left cranial abdominal quadrant (either enlarged left adrenal or lymph node)
Next
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Ultrasound and fine need aspirate and/or biopsy
2 yr old FS Shih Tzu
“Jolie”
• HX = Presented
for vomiting and
signs of dementia,
blood work is
pending.
Following
evaluation of the
radiographs a
splenoportogram is
ordered.
2 yr old FS Shih Tzu
“Jolie”
2 yr old FS Shih Tzu
“Jolie”
2 yr old FS Shih Tzu
“Jolie”
2 yr old FS Shih Tzu
“Jolie”
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RF
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The liver is small.
Faint areas of mineralization are seen associated with the renal pelvis.
The urinary bladder is distended.
The contrast that enters the splenic vein proceeds to a venous structure that appears to be
somewhat tortuous.
Also, there is reflux of some contrast material into the splenic parenchyma.
Contrast extends through a vessel which connects the splenic vein directly to the caudal
vena cava at the level of T13.
Contrast is also visible in the cardiovascular structures and urinary system and it outlines
multiple small calculi.
RD
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Portosystemic shunt
14 yr old MC DSH
• HX = cranky, depressed, emaciated with pale mucous
membranes
14 yr old MC DSH
14 yr old MC DSH
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RF
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RD
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Enlarged liver with irregular margins extending well beyond the costal arch.
Right-sided liver mass displacing the right kidney caudally.
Stomach axis is caudally positioned.
Diminished detail in the cranial and mid-abdomen.
Misshapen right kidney, left kidney is smaller than the right.
Stomach and colon contain mineral material.
Collapse of the lumbosacral disc space, spondylosis.
Hepatic enlargement
Possible liver mass(es)
Free abdominal fluid
Asymmetric and misshapen kidneys
Next
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Ultrasound and biopsy