Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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Chapter Three The Abd omen 405 der wall; and the presence or absence of material within the contrast puddle on the double-contrast cystogram. Shape. Changes in the shape of the bladder may indicate the presence of a bladder diverticulum, persistent urachal remnant, localized mural or extramural inflammation, or neoplasm. Diverticula are protrusions of the lumen and cystic mucosa through a rent in the serosa. 692 They will appear as extensions of either the gas or contrast medium beyond the serosal border of the bladder but are contained within the bladder wall. These may be congenital or acquired as a result of trauma. The urachus normally involutes immediately after birth to become the middle ligament of the bladder. When this occurs, the cranial wall of the bladder remains regular and smooth. In some instances, involution is incomplete or the urachal remnant becomes recanalized and provides an outpouching of the bladder lumen on its cranioventral aspect (Fig. 3-198). Diverticula and persistent urachal remnants provide an area for urine retention and stagnation. This situation may predispose to chronic cystitis but also can be the result of the dysuria from cystitis. Infiltrative tumors and granulomas (e.g., from a uterine stump) may interfere with normal bladder distention and may alter the shape of the bladder. These also produce a mass within the bladder lumen that is much more easily detected on a cystogram than is the lack of bladder wall distensibility. Bladder Wall Changes. Bladder wall changes are the most common cystographic abnormality. The normal bladder wall appears very smooth and consistent in thickness, approximately 1 to 2 mm. The appearance of even a few millimeters of increased thickness compared with the rest of the bladder wall is significant. Bladder wall thickening and irregularity, which is associated with the inflammation of cystitis, usually is seen in the cranial ventral aspect of the bladder (Fig. 3-199). One theory is that this site is predisposed to change because it is normally the most dependent portion of the bladder; therefore bacteria and other particulate matter tend to accumulate there. Another consideration is that it may be the site most predisposed to retention of small amounts of urine and, therefore, to the greatest exposure to toxic or inflammatory substances. The entire bladder circumference may become thickened and irregular secondary to chronic inflammation. This is common in the sterile cystitis associated with cyclophosphamide therapy. 693-695 Bladder wall ulceration is most commonly associated with cystitis. The ulcers appear as small areas of contrast medium adhering to the bladder wall (Fig. 3-200). However, when severe ulceration is noted, more aggressive processes should be considered. 696-698 The other major cause of bladder wall thickening is neoplasia. The most common tumor of the bladder is transitional cell carcinoma. This is usually focal in nature but may, on occasion, be generalized and diffuse. The mucosal surface may be smooth, but more commonly it is thrown up into folds, with masses protruding into the lumen of the bladder. Occasionally, a focal tumor may cause bladder wall thickening on the cranial ventral aspect of the bladder, making Fig. 3-198 A 1-year-old neutered female domestic short-haired cat with urinary tract infections for the past 5 months. A, There is a projection of a tubular-shaped, soft-tissue density extending from the apex of the urinary bladder toward the umbilicus (white arrows). B, The double-contrast cystogram revealed contrast medium within the tubular structure (white arrow). Differential diagnoses include persistent urachal remnant or cystic diverticulum due to other causes (trauma). Diagnosis: Persistent urachal remnant. A B
406 Small Animal Radiolo g y and Ultrasono graphy Fig. 3-199 A, A 10-year-old neutered female mixed breed dog with pollakiuria and hematuria for 2 months. Survey radiographs were normal. The double-contrast cystogram revealed mild thickening of the cranial ventral portion of the bladder (white arrows). Differential diagnoses include cystitis, cystic neoplasia, or cystic granuloma. Diagnosis: Cystitis. B, A 9-year-old male domestic short-haired cat with chronic hematuria. The lateral view of the positivecontrast cystogram revealed marked thickening of the cranial ventral part of the bladder. Contrast medium has dissected partially through and under this mucosal thickening. Diagnosis: Cystitis with the dissection of contrast medium into the submucosa. C, A 5-year-old male Samoyed with chronic hematuria. The pneumocystogram revealed multiple, focal tissue densities projecting into the bladder lumen as well as marked thickening of the entire bladder wall. Differential diagnoses include polypoid cystitis and bladder neoplasia. Diagnosis: Polypoid cystitis. A B C
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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 15 malitie
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Chapter One Introduction 17 indicat
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Chapter One Introduction 19 Fig. 1-
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Chapter One Introduction 21 Fig. 1-
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Chapter One Introduction 23 24. Lev
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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. 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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