- 15 yr old 75lb FS Lab Ret that is no longer able to walk due to chronic, severe arthritis. The dog has protein losing nephropathy and is mildly azotemic. Dog also has recurrent UTI’s, urinary retention, and urinary incontinence. Primary vet wanted to rule out bladder neoplasia. In addition, there was concern for a possible thoracic mass based upon chest films.
- Abdominal US showed a markedly distended bladder and a slightly enlarged left adrenal gland with no evidence of any local vascular invasion. No other abnormalities were seen.
- 15 yr old 75lb FS Lab Ret that is no longer able to walk due to chronic, severe arthritis. The dog has protein losing nephropathy and is mildly azotemic. Dog also has recurrent UTI’s, urinary retention, and urinary incontinence. Primary vet wanted to rule out bladder neoplasia. In addition, there was concern for a possible thoracic mass based upon chest films.
- Abdominal US showed a markedly distended bladder and a slightly enlarged left adrenal gland with no evidence of any local vascular invasion. No other abnormalities were seen.
- I suspect the UTI’s are secondary to urinary retention (neurological disease), pred therapy, and or possible hyperadrenocorticism (based upon enlarged LAG).
- Echocardiogram was normal except for decreased LVIDd (35.2) and slightly increased LVPWd (15.8) and increased IVSd (14.8). The LA was normal at 26.4mm and the LA:Ao was normal at 0.88. No other abnormalities were seen. No masses and no effusions. The MPA was 21.3mm and the MPA:Ao was 0.93.
- I suspect the UTI’s are secondary to urinary retention (neurological disease), pred therapy, and or possible hyperadrenocorticism (based upon enlarged LAG).
- Just wanted to get your thoughts on the chest rads. I don’t see a mass here. Just a prominent aorta and am not sure what to make of that since the echo was relatively normal. I did recommend blood pressure measurements.
- What do you people think of the rads? Why does the aorta stand out so much?
Comments
Hi Electrocute,
These x-rays
Hi Electrocute,
These x-rays were interesting to me. I made a screen shot of the last lateral shown and asked Dr Stefanacci to give me an opinion.
Here is his response:
Hi Randy…. hope you are well. This is a very interesting radiograph. The aortic arch is more opaque and larger in diameter than normal (or expected) and blends into the descending aorta, which appears normal, ventral to the T4 vertebae
This aortic arch enlargement could represent several pathologies:
* Aortic aneurysm, especially if this animal has systemic hypertension.
* Chronic low grade sub-arotic stenosis with post stenotic dilation
* A low grade intraluminal thrombus (rare)
* An intra luminal neoplasm (rare)
* The increased opacity of this part of the aorta could represent subtle intimal dystropic mineralization (occurs in some animals with or without sytemic hypercalcemia) or could be a radiographic summation artifact, especially if there is intraluinal soft tissue pathology.
The VD or DV view could b ehelpful here if there is a prominet aortic “bulge” at the 11-1 o’clock cardiac position (I did not give him the VD and it looks normal to me anyway)
And of course, cardiac ultrasound should help determine any pathology present.
Hope this helps!
Jay Sefanacci DVM (Radiologist)
Update on this dog would be appreciated if you have any news.
Thanks Randy! Please pass on
Thanks Randy! Please pass on my thanks to Dr. Stefanacci as well. I did not appreciate any aortic dilation in my standard RP and LP views but am wondering if I needed to be able to follow out the aorta more distally from the heart in order to appreciate the changes seen on the radiographs. I do believe that this dog is being treated for systemic hypertension and so of the possible differentials, I would have aneurysm as most likely. I did not appreciate any masses or thrombi. I also did not pick up any AI. I will see if I can add some US pictures to my original post.