Атлас по рентгенологии травмированных собак и кошек / an-atlas-of-radiology-of-the-traumatized-dog-and-cat

242 Radiology of Abdominal Trauma

Case 3.23

3

Noncontrast

Signalment/History: “Frodo”, an 11-month-old, female

DSH cat, was presented with a painful attitude.

Physical examination: She was febrile and had abrasions on the skin of the right pelvic limb. Palpation of the abdomen disclosed pain principally on the left. Trauma was suspected.

Radiographic procedure: Abdominal studies were made and were followed by an intravenous urogram.

Radiographic diagnosis (noncontrast): The left kidney was displaced laterally with an indistinct soft tissue shadow located at the side of its shadow. On the lateral view, the sublumbar musculature was not sharply contrasted against the retroperitoneal fat, and fluid was suspected in that compartment. These findings suggested retroperitoneal fluid, perhaps urine, and an intravenous urogram was performed.

Renal, ureteral, and urinary bladder injury 243

3

Intravenous urogram

Radiographic diagnosis (intravenous urogram): Studies made at 30 minutes following injection of the contrast agent demonstrated hydronephrosis in the left kidney with distention of the proximal portion of the left ureter and leakage of urine containing the contrast agent into the retroperitoneal space. The distal portion of the left ureter was filled with contrast agent. The study showed a normally functioning kidney on the right side and filling of the urinary bladder with contrast agent.

Treatment/Management: An unsuccessful attempt at surgical repair of the torn ureter was followed by a second operation in which the affected kidney and proximal ureter were surgically removed. The filling defect in the proximal portion of the urinary bladder was probably caused by a blood clot. “Frodo” recovered and renewed his search for Sam and Gollum.

244 Radiology of Abdominal Trauma

Case 3.24

3

Noncontrast

Signalment/History: A male DSH cat was found lying near the side of the highway after apparently being struck by a car.

Radiographic procedure: Whole body studies were made, followed by an intravenous urogram.

Radiographic diagnosis (noncontrast): Small bowel loops were seen to “float” within an abdomen thought to contain peritoneal fluid. The urinary bladder could not be clearly identified. Because of these findings, it was assumed that the urinary bladder might be ruptured and an intravenous urogram was performed.

Renal, ureteral, and urinary bladder injury 245

3

Intravenous urogram

Radiographic diagnosis (intravenous urogram): Radiographs were made at 10 minutes and filling of the renal pelves was evident. At 20 minutes, the hold-up of contrast agent in the renal pelves was abnormal and the filling of the proximal ureters suggested ureteritis, which could have been post-trau- matic. However, the major finding was the leakage of contrast agent into the perirenal tissues on the left (arrows). A diagnosis of a ruptured kidney was made.

Treatment/Management: The rupture of the kidney was followed clinically and the cat improved without surgical intervention and was discharged after three weeks. Radiographs made two years later showed the left kidney to be of normal size, shape, and position.

Comments: Even despite its retroperitoneal position, renal injury often causes tearing of the peritoneum and leakage of urine or blood into the peritoneal space.

246 Radiology of Abdominal Trauma

3.2.6Urethral injury

Case 3.25

3

Noncontrast

Signalment/History: “Rogue”, a 2-year-old, male Bichon

Frise, was presented with a history of recurrent urinary calculi.

Physical examination: The urinary bladder was easily palpable. Physical examination was limited because of the questionable status of the bladder and urethra.

Radiographic procedure: Routine studies were made of the caudal abdomen, followed by retrograde urography.

Radiographic diagnosis (noncontrast): The noncontrast studies showed a distended bladder with air bubbles probably secondary to the removal of urine from the bladder. No cystic or urethral calculi were noted. The absence of peritoneal contrast suggested the presence of peritoneal fluid.

Radiographic procedure (retrograde urography): The catheter tip was positioned within the penile urethra and a radiograph made following a small injection of positive contrast agent. Subsequently, a larger injection was made.

The flow of contrast agent outlined a badly damaged urethral mucosa at the urethral arch with extravasation of the contrast agent into the periurethral tissues. The prostatic urethra was dilated. A portion of the contrast agent flowed into the urinary bladder, which appeared intact.

248 Radiology of Abdominal Trauma

Case 3.26

3

Noncontrast

Signalment/History: “Andy”, a 1-year-old, male DSH cat, was presented for emergency treatment of a blocked urethra. He had had dysuria for seven days and was thought to have not urinated for at least 24 hours prior to presentation.

Physical examination: A large, firm bladder was palpated and a local anesthetic was sprayed into the urethra. Immediately following this medication, the bladder could not be palpated.

Radiographic procedure: Noncontrast studies of the abdomen were made and followed immediately by a retrograde urethrocystogram.

Radiographic diagnosis (abdomen): Distention of the small bowel was indicative of a paralytic ileus. The loss of abdominal detail suggested the presence of peritoneal fluid while the pattern of free peritoneal air indicated a pneumoperitoneum.