Thickened bladder wall with irregular mucosa in a 7 year old mn Puggle

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Thickened bladder wall with irregular mucosa in a 7 year old mn Puggle

  • 7 year old mn Puggle presented for hematuria seen at the end of micturition.
  • Urinlalysis showed hematuria, proteinuria, USG=1.044, no bacteria seen.
  • Urinary tract ultrasound shows a diffusely thickened bladder wall with irregular mucosa, shadowing, gravity-dependent echogenic sediment (or small stones), and swirling intraluminal content.  Echogenic foci are also present throughout the bladder lumen.
  • 1mg/kg furosemide was given IV to futher distend the bladder lumen but had minimal effect after 15 minutes.

    • 7 year old mn Puggle presented for hematuria seen at the end of micturition.
    • Urinlalysis showed hematuria, proteinuria, USG=1.044, no bacteria seen.
    • Urinary tract ultrasound shows a diffusely thickened bladder wall with irregular mucosa, shadowing, gravity-dependent echogenic sediment (or small stones), and swirling intraluminal content.  Echogenic foci are also present throughout the bladder lumen.
    • 1mg/kg furosemide was given IV to futher distend the bladder lumen but had minimal effect after 15 minutes.
    • It is difficult to determine what is bladder wall and what is intraluminal content.  Color flow Doppler was not that helpful as the patient’s increased respiratory rate created too much movement.
    • My primary differential is chronic cystitis with concurrent bladder sand or small stones.  Any grounds for emerging neoplasia here?
    • I am also wondering about the intraluminal echogenic foci…mineralization?  blood clot? gas?

     

Comments

EL
March 19, 2016 at 11:18 am -

I just see suspended ghosts

I just see suspended ghosts and debris and sand in the still images no evidence of neoplasia but i dont see deep urethra views as well. May want to get those views so you don’t miss a urethral lesion …. something like this:

http://sonopath.com/members/case-studies/cases/0600342-butter-c-mineralizing-urethral-mass

Regarding scanning technique on the urethra and elsewhere you may benefit from our 17 point abdomen download to ensure you are getting the complete views and proper depth:

https://sonopath.com/products/downloadable

Otherwise urine culture and even anaerobic culture… baytril or similar 6 weeks and rescan at 4 assuming baytril works with the sensitivity results. treatign underlying uti usually allows for sand dissolution in these cases… staph based usually.

Electrocute
March 19, 2016 at 3:55 pm -

Thanks Eric.  I did get the

Thanks Eric.  I did get the urethral views but did not post them.  Proximal urethra and prostate appear normal.  There is also no history of dysuria or stranguria.  The owner is just observing blood at the end of micturition.  So, I also recommended a CBC just to make sure there isn’t any thrombocytopenia.

 

What is a suspended ghost?  Artifact?

EL
March 19, 2016 at 11:45 pm -

Then its likely the sand

Then its likely the sand doing the lava lamp thing and plugging up. Ghosts are those sespended focal echos with the comet tail

randyhermandvm
March 23, 2016 at 11:04 pm -

Hi Electrocute,
This looks

Hi Electrocute,

This looks like a chronic cystitis case that I posted some time ago.

I am going to include the link. The chronic cystitis protocol worked great and

recheck ultrasound resolved the cystitits. 

Even though no bacteria was noted in in the urine I would still suggest a urine MIC.

https://sonopath.com/forum/chronic-cystitis

 

Electrocute
March 25, 2016 at 2:29 am -

Thanks Randy!  That is very

Thanks Randy!  That is very helpful.  Hope all is well in the North Metro.  

randyhermandvm
March 25, 2016 at 9:42 am -

All is well. Thanks
 

All is well. Thanks

 

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