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13 year old fs DSH with acute onset hematuria, vomiting, dysuria, anorexia
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Diagnosed with possible bladder mass at the Emergency clinic
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US showed
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Bladder: free moving intraluminal blood clot/mucus/sediment ball, and echogenic urine suggestive of hematuria but no bladder or trigone wall masses
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Left kidney: rounded shape, renolithiasis, but no overt obstruction
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13 year old fs DSH with acute onset hematuria, vomiting, dysuria, anorexia
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Diagnosed with possible bladder mass at the Emergency clinic
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US showed
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Bladder: free moving intraluminal blood clot/mucus/sediment ball, and echogenic urine suggestive of hematuria but no bladder or trigone wall masses
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Left kidney: rounded shape, renolithiasis, but no overt obstruction
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Right kidney: small (2.0cm), misshapen with evidence of previous infarcts, thickened renal cortex and loss of corticomedullary definition, multiple echogenic foci at the corticomedullary junction, and echogenic perirenal fat
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My primary differential is chronic intermittent renal stone passage with concurrent pyelonephritis…any other thoughts?
- Recommendations are urinanalysis, urine culture, fluids, antibiotics, analgesics and possible cystourethrogram to evaluate the mid to distal urethra if dysuria persists.
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Comments
Would agree with your
Would agree with your differentials and recommondations. May also consider pyelocentesis and possibly FNA of the kidney, the latter as neoplasia could be a consideration.
Would agree with your
Would agree with your differentials and recommondations. May also consider pyelocentesis and possibly FNA of the kidney, the latter as neoplasia could be a consideration.
Does a smaller kidney size
Does a smaller kidney size make neoplasia less likely? The left kidney measured 3.1cm in length and the right kidney barely exceeded 2.0cm.
Does a smaller kidney size
Does a smaller kidney size make neoplasia less likely? The left kidney measured 3.1cm in length and the right kidney barely exceeded 2.0cm.
Electrocute nice images.
Electrocute nice images. This looks like a stone mover and apsular swelling and infarcts. What happens depending on the moment you scan the patient the stone may be at the CM junction, the pelvis, moving down the ureter causing hydro and renal swelling then moves it through hopefully… but the kidney swells and gets hyperechoic ill defined fat around th ecalsule like you have in image on the bottom right at 2 o’clock position and inflammation and infarcts occur in various phases of the smoldering ddisease. Renal infection also often present hence the pyelocentesis and 25 g fna of the cortex will likely give you a mixed bag of inflammation here as opposed to a monocellular lympoid/lymphoma population. LSA kidneys can look like this but when there are stones and big kidney little kidney syndromes with lumped up shape they are usually stone movers.
Electrocute nice images.
Electrocute nice images. This looks like a stone mover and apsular swelling and infarcts. What happens depending on the moment you scan the patient the stone may be at the CM junction, the pelvis, moving down the ureter causing hydro and renal swelling then moves it through hopefully… but the kidney swells and gets hyperechoic ill defined fat around th ecalsule like you have in image on the bottom right at 2 o’clock position and inflammation and infarcts occur in various phases of the smoldering ddisease. Renal infection also often present hence the pyelocentesis and 25 g fna of the cortex will likely give you a mixed bag of inflammation here as opposed to a monocellular lympoid/lymphoma population. LSA kidneys can look like this but when there are stones and big kidney little kidney syndromes with lumped up shape they are usually stone movers.
Its seems that the usual
Its seems that the usual causes of thromboembolic disease are associated wiht renal infarcts in cats. I ran across this article on renal infarcts:
Article Abstract
BACKGROUND: Renal infarcts identified without definitive association with any specific disease process. OBJECTIVE: Determine diseases associated with diagnosis of renal infarcts in cats diagnosed by sonography or necropsy. ANIMALS: 600 cats underwent abdominal ultrasonography, necropsy, or both at a veterinary medical teaching hospital. METHODS: Information obtained from electronic medical records. Cats classified as having renal infarct present based on results of sonographic evaluation or necropsy. Time-matched case-controls selected from cats that underwent the next scheduled diagnostic procedure. RESULTS: 309 of 600 cats having diagnosis of renal infarct and 291 time-matched controls. Cats 7-14 years old were 1.6 times (odds ratio, 95% CI: 1.03-2.05, P = .03) more likely to have renal infarct than younger cats but no more likely to have renal infarct than older cats (1.4, 0.89-2.25, P = .14). All P = .14 are statistically significant. Cats with renal infarcts were 4.5 times (odds ratio, 95% CI: 2.63-7.68, P < .001) more likely to have HCM compared to cats without renal infarcts. Cats with renal infarcts were 0.7 times (odds ratio, 95% CI: 0.51-0.99, P = .046) less likely to have diagnosis of neoplasia compared to cats without renal infarcts. Cats with diagnosis of hyperthyroidism did not have significant association with having renal infarct. Cats with renal infarcts were 8 times (odds ratio, 95% CI: 2.55-25.40, P ≤ .001) more likely to have diagnosis of distal aortic thromboembolism than cats without renal infarcts. CONCLUSIONS AND CLINICAL IMPORTANCE: Cats with renal infarcts identified on antemortem examination should be screened for occult cardiomyopathy.
Its seems that the usual
Its seems that the usual causes of thromboembolic disease are associated wiht renal infarcts in cats. I ran across this article on renal infarcts:
Article Abstract
BACKGROUND: Renal infarcts identified without definitive association with any specific disease process. OBJECTIVE: Determine diseases associated with diagnosis of renal infarcts in cats diagnosed by sonography or necropsy. ANIMALS: 600 cats underwent abdominal ultrasonography, necropsy, or both at a veterinary medical teaching hospital. METHODS: Information obtained from electronic medical records. Cats classified as having renal infarct present based on results of sonographic evaluation or necropsy. Time-matched case-controls selected from cats that underwent the next scheduled diagnostic procedure. RESULTS: 309 of 600 cats having diagnosis of renal infarct and 291 time-matched controls. Cats 7-14 years old were 1.6 times (odds ratio, 95% CI: 1.03-2.05, P = .03) more likely to have renal infarct than younger cats but no more likely to have renal infarct than older cats (1.4, 0.89-2.25, P = .14). All P = .14 are statistically significant. Cats with renal infarcts were 4.5 times (odds ratio, 95% CI: 2.63-7.68, P < .001) more likely to have HCM compared to cats without renal infarcts. Cats with renal infarcts were 0.7 times (odds ratio, 95% CI: 0.51-0.99, P = .046) less likely to have diagnosis of neoplasia compared to cats without renal infarcts. Cats with diagnosis of hyperthyroidism did not have significant association with having renal infarct. Cats with renal infarcts were 8 times (odds ratio, 95% CI: 2.55-25.40, P ≤ .001) more likely to have diagnosis of distal aortic thromboembolism than cats without renal infarcts. CONCLUSIONS AND CLINICAL IMPORTANCE: Cats with renal infarcts identified on antemortem examination should be screened for occult cardiomyopathy.