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The Value of a Negative Sonogram

Case Of the Month

The Value of a Negative Sonogram

The patient was presented due to persistent vomiting for 3 weeks. Physical examination found the patient 5% dehydrtated. Blood chemistry found a high BUN of 94 and high creatinine of 3.2. USG was 1.032 (in the face of 5% dehydration).

The patient was presented due to persistent vomiting for 3 weeks. Physical examination found the patient 5% dehydrtated. Blood chemistry found a high BUN of 94 and high creatinine of 3.2. USG was 1.032 (in the face of 5% dehydration).

DX

Gastric hairball or foreign matter. Medullary rim kidney, potential underlying toxic event or FIP.

Outcome

Stabilization of the azotemia followed by gastrotomy and renal biopsy was recommended in this patient. Guarded prognosis depending upon underlying histopathology.

Image Interpretation

The urinary bladder, trigone and pelvic urethra presented normal wall thicknesses with anechoic urine and normal tone. No uroliths or sediment were visualized. No evidence of inflammatory or neoplastic changes were noted. The ureters were not visible and considered normal. The kidneys presented mildly swollen contour. The left kidney measured 4.6 cm with corticomedullary mineralization. The right kidney measured 4.66 cm. Both adrenal glands were visualized and recognized as having normal shape, size, position and echogenicity for this breed. The phrenic vasculature, glandular echogenicity and detail were acceptable. Capsule, cortex, and medullary distinction and definition were normal for this age patient. The spleen presented a smooth homogeneous parenchyma hyperechoic to liver and kidney. The capsule was smooth without noticeable impingement from within the spleen or from pathology in the adjacent abdomen. The splenic vasculature demonstrated normal volume without signs of congestion, significant contraction, or thrombosis. No evidence of acute or chronic inflammatory, neoplastic, or infarctual changes were noted. The liver images from right and left intercostal as well as subcostal views revealed subjectively normal liver size, contour, and structure. Parenchymal echogenicity was naturally coarse and hypoechoic to the spleen. Vascular and biliary tracts were of normal volume and no evidence of congestion was noted. The gallbladder was double layered and echogenic. The stomach revealed a 4.37 cm shadowing structure. The small intestine was unremarkable. The pancreas was slightly enlarged with a dilated duct measuring approximately 0.6 cm.

UA Specific Gravity Range

1.032

Patient Information

Gender : Female, Intact
Species : Feline

Clinical Signs

  • Vomiting

Exam Finding

  • Dehydration

Images

022515_nh_healingheart_hendricks_20150225_183346_0016022515_nh_healingheart_hendricks_20150225_183346_0010022515_nh_healingheart_hendricks_20150225_183346_0028022515_nh_healingheart_hendricks_20150225_183346_0011022515_nh_healingheart_hendricks_20150225_183346_0021

Blood Chemistry

  • BUN high
  • Creatinine, High

Clinical Signs

  • Vomiting