Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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Chapter Three The Abd omen 325 Fig. 3-90 A 9-year-old male Giant Schnauzer with vomiting for 1 week and melena and hematemesis for 2 days. The ventrodorsal double-contrast gastrogram (performed immediately after a GI series that had normal results) revealed an irregularly oval structure outlined by a thin line of barium just to the right of the midline and on the caudal wall of the stomach (solid white arrow). A similar lesion is poorly outlined on the cranial body wall of the stomach (open white arrow). The pylorus is tightly closed in this view and the normal mucosal folds are coated with barium. Diagnosis: Benign gastric ulcers. Pyloric outflow obstruction may be recognized during the ultrasonographic examination. Symmetric or asymmetric thickening of the pylorus or a mass may be observed. Hypertrophic pyloric gastropathy produces a uniform thickening of the hypoechoic muscular layer of the pylorus. The extent of pyloric wall thickening varies from 9 to 19 mm, with the thickness of the muscularis ranging from 3.0 to 5.4 mm. Gastric distention and vigorous peristalsis were also observed. 343 A thickened gastric wall, thickened rugal folds, and loss or decreased definition of the normal gastric wall layers were identified ultrasonographically in dogs with uremic gastritis. A hyperechoic line identified at the mucosal-luminal junction was associated with gastric mineralization. 344 Changes in the mucosal surface representative of ulcers also may be identified by ultrasonography. 345 Foreign bodies may be identified using ultrasonography. Most foreign bodies will be hyperechoic, will have sharply defined margins, and will have distal shadowing. 336,346 Foreign bodies will move readily within the stomach with changes in the patient’s position. Chunks of dry dog food may have a similar appearance; however, their large number and uniform size will make them easily recognizable. Gastrogastric intussusception was identified during an ultrasonographic examination. A spiraled, tapered echogenic mass was seen in the gastric fundus. The pyloric antrum and the body of the stomach could not be identified. 328 PA N C R E A S Density Changes. Pancreatic lesions are frequently difficult to define radiographically. Although several radiographic findings have been described in association with pancreatitis, it is our experience that none of the radiographic findings is reliably present and the absence of these findings in any specific case should not preclude the diagnosis of pancreatitis. 347,348 The most commonly seen radiographic change is an apparent haziness and loss of detail in the cranial right or middle abdomen. 349,350 This change must be interpreted cautiously, because most animals have poor detail in this area due to the large number of contiguous and adjacent fluid-dense structures. The proximal duodenum may be dilated and fixed in diameter in response to the local inflammation. A similar rigidity may be observed in the gastric wall adjacent to the left limb of the pancreas. In the ventrodorsal radiograph, the proximal duodenum may be displaced toward the right lateral abdominal wall and the pylorus may be displaced toward the midline. This widens the angle or curve between the pylorus and proximal duodenum. The transverse colon may be displaced caudally away from the stomach and may be either distended and fixed in diameter or completely empty. In severe pancreatitis, there also may be a haziness throughout the entire abdomen (Fig. 3-94).
326 Small Animal Radiolo g y and Ultrasono graphy Fig. 3-91 A, An 11-year-old female mixed breed dog with chronic vomiting for 2 months. The ventrodorsal double-contrast gastrogram revealed an irregular ridge of tissue in the body of the stomach, the whole surface of which was outlined by barium (open white arrows). This ridge of tissue extended to blend in with the normal serosal border (solid white arrow). This indicated a thickening of the gastric wall. Differential diagnoses include gastric neoplasia (particularly adenocarcinoma) or granuloma. Diagnosis: Gastric adenocarcinoma. B, A 13-year-old female Dandie Dinmont Terrier with previous laminectomy for disc extrusion (the reason the largegauge wire is superimposed over the spine), multiple partial gastrectomies for gastric mass resections (fine metal staples in gastric wall extending cranial and caudal from the black arrow), and a splenectomy performed along with the first gastrectomy due to the extension of the mass into the gastrosplenic ligament. The ventrodorsal double-contrast gastrogram revealed an area of marked narrowing of the gastric body (due to the previous surgeries, solid black arrow). A small mural mass is seen on the caudal wall of the body of the stomach; it protrudes into the lumen of the stomach (white arrows). This mass has been followed for 2 years by sequential radiographs that show no change in its size. Histology of the previously resected masses revealed granulomatous reaction. Diagnosis: Recurrent gastric granuloma with no increase in size for 2 years. A B Pancreatic Masses. Pancreatic neoplasia, pseudocyst, and abscess produce identical radiographic changes. 351-360 Pancreatic masses such as carcinoma, pseudocyst, abscess, or “bladder” formation may involve the duodenum or stomach wall (Figs. 3-95 and 3-96). 348,351 These lesions produce radiographic changes similar to pancreatitis; occasionally, however, the outline of the mass may be observed. The mass may interfere with normal gastric or duodenal peristalsis, producing a fixed or rigid wall. The lesions may distort the shape of the stomach or intestine and may be difficult to distinguish from intramural lesions. The transverse colon may be displaced caudally, and the descending
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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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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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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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