Transcript VCA 341 Midterm: Urinary Cases

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Reading Radiographs…
Like a CSI
Dr. LeeAnn Pack
Diplomate ACVR
Requirements for becoming a
Veterinary Radiographic CSI
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Doctor of Veterinary Medicine degree
Keen eye for detail
No tunnel vision
Does not give up the search
Tools of the Trade
• Signalment
– Breed specific diseases
– Age
– Gender and reproductive status
• History
– Trauma
– Past medical history
• Physical Examination
Tools of the Trade
• The radiograph
– Film
• Hot light
– Digital
• Window/levels
• Quiet, darkened room
– Ambient lighting
Normal Anatomy
• You can not recognize abnormal anatomy if
you can not recognize normal anatomy
• Young animals
– Physis – where are they and when do they close
• Species differences
– MD vs. DVM
• An Atlas of Interpretative Radiographic
Anatomy – 2nd Ed Arlene Coulson - Blackwell
Cat elbow
Look to a book!
Normal Anatomic Variants
• Can easily be mistaken for pathology
• Sesamoids
Pattern Recognition - Normal
• We have an idea of what the film is supposed
to look like
Pattern Recognition - Abnormal
• Common pathological appearance of disease
– The large breed dog – lame – metaphyseal lysis
– Wheezing cat with donuts and rail road tracks
– A blown cruciate
What is the most likely diagnosis?
It is hard to see what one is not
looking for...
• 8 month old German Shorthair Pointer
• Lame – owner thinks right front limb
• Physical Exam – pain on manipulation of the
right shoulder
– What are things we are thinking about?
– What radiographs should be made?
GSP Ante brachial lateral
Complete radiographic study
• Minimum 2 views made 90 degrees to each
other for most parts
– Single films rarely suffice
• Pregnancy
• Bladder present
• Colon size
• Number of views needed = number to
demonstrate the abnormality
• Malpractice
The big picture is important... But
so are the details
Did you see the abnormality?
Important points
• Be certain to look at the ENTIRE radiograph
• Peripherally positioned pathology is more
likely to be missed
• Sometimes things are unexpected
– We tend to look for things in the context of
patient presentation
• What the owner tells us
• What we are suspicious of from our physical exam
Artifacts et al
• Artifacts can mimic pathology
– Skin folds vs. pneumothorax
• Artifacts can obscure pathology
– Atelectasis due to prolonged recumbency
• If the images are suboptimal
– The diagnosis will likely suffer the same fate
What is the diagnosis?
Satisfaction Syndrome
• We tend to stop looking when we find a
reason for the patient’s clinical signs
– We look for what we think it is...
– We find it
– We are happy with ourselves
– We stop and treat
Meet Chester
• A 5 year old M/N Scotty
• History
– Inappropriate urination, hematuria
What is the radiographic
diagnosis?
Now what does this add and what
does it mean?
Tina
• A 10 year old F/S DSH
• History of constipation
– Owner was a pilot and cat did not want to drink
when owner was away
– Was given an enema
– Esophageal tube placed to give laxative
Tina
Lex
• 8 yo Borizoi
• Owner noticed swelling along dog’s back and
ventral abdomen
• Abdominal radiographs were made
Lex
What is the radiographic
diagnosis?
What questions do we have?
Does this help us answer them?
Rabbit
• Presented to the referring vet for head
shaking
• During physical exam DVM took rabbit’s temp
• Rabbit moved and thermometer cover
“sucked” into rectum
• Oh no... lets take rads and see where it is
Rabbit
Rabbit
Now you see it - Now you don’t
Let’s work a heart case
Another Diagnostic Test
• Sometimes on radiographs we are uncertain
of what we see
• What can we do?
– Ask another in the practice for an opinion
– Send to a radiologist for an opinion
– Refer
– Another diagnostic test
What do we see?
Does this add anything?
Retrograde + contrast urethrogram
Scratches head – then hangs head
Diagnosis?
Diagnosis?
Diagnosis?
Kelbee
• 8 yo FS Catahoula
• Feb - Owner in Cancun – pet sitter said dog
ate part of hand towel
• Thought dog vomited it up
• Radiographs and US were normal
Kelbee
• End March
• Owner said dog ate part of hand towel
– Owner said dog never did this as puppy
– Now on second episode
• Back in for more rads
Kelbee March 28th 1pm
Kelbee March 28th 9pm
Kelbee March 31st 3:30pm
Kelbee Ultrasound
Re-certification
• Attending continuing education
– General
– Specific
• Reputable on-line resources
• Reading – books, journal articles
• Why is it important?
What is the radiographic
diagnosis?
Be a Radiographic CSI and Don’t
Let the Bad Guys Get Away
Questions?
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