Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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Chapter Three The Abd omen 323 ographically but can cause outflow obstruction. 333 Mucosal hypertrophy may be symmetric or asymmetric and may be evident only when a wave of peristalsis pushes the contrast material into the pylorus. When this occurs, the normal pylorus should be convex on both the cranial and caudal aspects. Mucosal hypertrophy may produce a concavity or flattening on one side. This should be evident in more than one radiograph during the GI series. Double-Contrast Gastrography Ulcers. The double-contrast gastrogram is most helpful in evaluating the stomach for benign ulcers, but it is also useful in evaluating some mass lesions. 110,193 Benign gastric ulcers, which may be difficult to detect on a standard GI series, may become more readily apparent in the double-contrast study. When evaluating this study, the effects of gravity on the contrast medium and the normal gastric anatomy must be considered (Fig. 3-89). If located on a nondependent surface, the ulcers will be seen as lines running in directions other than the normal gastric rugal folds. On dependent projections, the barium will puddle in the ulcer crater (Fig. 3-90). Intramural and Intraluminal Lesions. The double-contrast gastrogram may be helpful in evaluating some cases of gastric carcinoma or other gastric wall masses, particularly if the masses are small or not located on one of the surfaces that is seen clearly on the regular GI series (Fig. 3-91). The contrast or air can be used to highlight the lesion by positioning the patient so that the lesion is dependent (surrounded by barium) or up (surrounded by air). The position of a filling defect during a double-contrast gastrogram is helpful in distinguishing between intramural and intraluminal objects. Intraluminal objects will move freely within the gastric lumen and will therefore move with the barium during the double-contrast examination. Intramural objects will remain fixed in location and will therefore be outlined with air on one view and with barium on the opposite view. Abnormal Gastric Ultrasonography. The stomach can be evaluated from left to right in a systematic fashion in both the longitudinal and transverse planes. Gastric wall symmetry can be observed and wall thickness can be measured, wall layers can be identified, extent of a wall lesion can be determined, and peristaltic activity can be observed. 18,334-336 The lumen of the stomach also can be evaluated provided the stomach contains fluid without a large amount of air or ingesta. In some animals, it may be necessary to fill the stomach with fluid to facilitate the ultrasonographic examination. This is rarely necessary but can be accomplished easily without sedation of the patient. Thickening of the gastric wall is the most common sonographic abnormality seen. 336 It must be interpreted cautiously because false-positive examinations have occurred. 337 Gastric wall thickening may be local or diffuse and symmetric or asymmetric. 338-343 Both tumors and granulomas produce local asymmetric thickening with disruption of the layers of the gastric wall (Fig. 3-92). Generalized thickening may occur with either inflammatory disease or infiltrative neoplasia (Fig. 3-93). Infiltrative neoplasia may disrupt the gastric wall and interfere with identification of the wall layers to a greater extent than inflammatory disease. 336 Gastric lymphoma has various manifestations. However, in cats a transmural circumferential lesion with disruption of the normal gastric wall architecture, decreased echogenicity, and local interference with peristalsis was the most common form observed. 338,339 Lymph node involvement was commonly identified. Intramural masses may be detected and may produce discrete rounded or lobulated lesions, which may be outlined by fluid within the gastric lumen. Localizing the mass to a distinct layer of the stomach is difficult. Most gastric masses are heteroechoic, and characterizing the mass as neoplastic or inflammatory is not possible. Observing the motion of the mass with change in position of the patient or gastric peristalsis is useful in determining whether the mass is intramural or intraluminal. Intramural lesions will be fixed in position despite peristalsis or changes in patient position. Intramural masses may also interfere with normal wall movement during peristalsis. It is more difficult to recognize diffuse gastric wall thickening. If the gastric wall diameter exceeds the normal range of 3 to 5 mm, the wall layers should be examined to see if they
324 Small Animal Radiolo g y and Ultrasono graphy A B C D Fig. 3-89 A 2-year-old male Persian cat with vomiting for 1 month. The double-contrast gastrogram performed immediately after a standard GI series was normal on all views: left lateral (A), right lateral (B), ventrodorsal (C), and dorsoventral (D). The various regions of the stomach that are visible on each view are labeled (c) cardia, (e) esophagogastric junction, (b) body, (f) fundus, and (p) pylorus. Diagnosis: Normal stomach on both double-contrast gastrogram and endoscopic examination. are asymmetrically widened or disrupted, and the gastric wall should be observed carefully during peristalsis to determine if there is a segmental loss of motility. Thickening of the gastric wall may be localized to a specific layer and this may be helpful in determining what disease is present. 336 Localized thickening of the gastric wall with a focal loss of peristalsis may be observed in association with pancreatitis. Recognition of the lesion within the pancreas will help to determine that the gastric wall thickening is secondary. Craters or defects may be identified within the thickened stomach wall when gastric ulcers are present.
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SAUNDERS An Imprint of Elsevier Sci
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C H A P T E R O N E Introduction GE
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Chapter One Introduction 3 Fig. 1-1
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metal. Soft tissues or organs surro
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Inadequate penetration will result
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Chapter One Introduction 9 signal i
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Chapter One Introduction 13 Mach ba
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Chapter One Introduction 21 Fig. 1-
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Chapter One Introduction 23 24. Lev
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26 Small Animal Radiolo g y and Ult
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A B C Fig. 2-63 A 10-year-old male
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Fig. 2-101 A 7-year-old male mixed
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Page 273 and 274: 272 Small Animal Radiolo g y and Ul
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Fig. 3-234 A 7-year-old female Brit
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Fig. 4-59 A 9-year-old female Russi
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Fig. 4-73 A 2-year-old female Saint
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Fig. 4-97 A 10-year-old male mixed
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Fig. 4-107 A 4-year-old male Chow C
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I N D E X A Abdomen, abnormal prese
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Index 729 Bone, cysts of, 525-527,
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Index 731 Ear, abscess of—cont’
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Index 733 Hydrocephalus—cont’d
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Index 735 Lungs. See also Pulmonary
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Index 737 Pregnancy, determination
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Index 739 S-shaped aortic deformity
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Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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