Hello. This is my first post. And not an earth-shattering one at that. But I am curious if anyone has seen this phenomenon. AND is it useful. The attached two clips are of a urinary bladder in an exotic short haired 4YO feline with stranguria. One sagittal view with CF and one without. I have been told that the color flow is artifact “speckling” that is caused by mineralization and should not be mistaken for actual blood flow. The apical bladder wall is abnormal. But is does not appear as a mass.
Hello. This is my first post. And not an earth-shattering one at that. But I am curious if anyone has seen this phenomenon. AND is it useful. The attached two clips are of a urinary bladder in an exotic short haired 4YO feline with stranguria. One sagittal view with CF and one without. I have been told that the color flow is artifact “speckling” that is caused by mineralization and should not be mistaken for actual blood flow. The apical bladder wall is abnormal. But is does not appear as a mass. If fact, after two weeks of antibiotic therapy and Hills SD multicare C/D, the mineralization and wall abnormality have resolved!
So, my questions are: do you agree with this ” sparkling” affect as being caused by mineralization and would the use of CF help differentiate the presence of mineralization vs. fibrosis in other tissues?
Many Thanks,
Tom
[videoembed id=6948] [videoembed id=6949]
Comments
Yes this is often a
Yes this is often a presentation in young/middle aged cats and we are doing a study on this. The echogenic debris is a mix of mucous and sand and in this cat the bladder is thick and there is a penetrating ulcerative lesion in the apex where the mucous embeds. This is a form of interstitial cystitis and occasionally bladder lsa will look like this. I encourage owners to have a cystotomy done to lavage the bladder but more importantly get histopath on the wall because some of these are lp infiltrates and respond to cortisone but dont want to blast empirically with pred if there is infection and cause perf. Also occasionally when you see that apical divit in the wall the bx when resected comes back urachocele/remnant which is another reason to cut it out if resectable. Owner must not expect a stone or sand in a jar though but the histopoath is what we go after and culture of the wall.
This is the only article we have found specifically on this subject aside from the usual feline cystitis material
Small Animal Internal Medicine 4th edition
Chpt 140
feline lower urinary tract diseases
osborn
Page 1829
Table 140-16
“mononuclear cell infiltration”
and for some reason the uro gods have not addressed this phenomenon in the research (even though those of us that scan all the time see it often and they are frustrating cases to manage) but we are so if anyone has clinical info with histopath please send it along but be sure to ask for predominant cell type on the infiltrates because the pathologist often omits this in the report for some reason. What to know is mixed inflammation vs neutrophilic, bacterial or lymphoplasmacytic (LP) which is what our study is about.
I like to call this LP interstitial cystitis, should that be the cell type “IBD-2” Inflammatory Bladder Disease:)
great first post!
Yes this is often a
Yes this is often a presentation in young/middle aged cats and we are doing a study on this. The echogenic debris is a mix of mucous and sand and in this cat the bladder is thick and there is a penetrating ulcerative lesion in the apex where the mucous embeds. This is a form of interstitial cystitis and occasionally bladder lsa will look like this. I encourage owners to have a cystotomy done to lavage the bladder but more importantly get histopath on the wall because some of these are lp infiltrates and respond to cortisone but dont want to blast empirically with pred if there is infection and cause perf. Also occasionally when you see that apical divit in the wall the bx when resected comes back urachocele/remnant which is another reason to cut it out if resectable. Owner must not expect a stone or sand in a jar though but the histopoath is what we go after and culture of the wall.
This is the only article we have found specifically on this subject aside from the usual feline cystitis material
Small Animal Internal Medicine 4th edition
Chpt 140
feline lower urinary tract diseases
osborn
Page 1829
Table 140-16
“mononuclear cell infiltration”
and for some reason the uro gods have not addressed this phenomenon in the research (even though those of us that scan all the time see it often and they are frustrating cases to manage) but we are so if anyone has clinical info with histopath please send it along but be sure to ask for predominant cell type on the infiltrates because the pathologist often omits this in the report for some reason. What to know is mixed inflammation vs neutrophilic, bacterial or lymphoplasmacytic (LP) which is what our study is about.
I like to call this LP interstitial cystitis, should that be the cell type “IBD-2” Inflammatory Bladder Disease:)
great first post!
@Eric Lindquist CEO/Founder
@Eric Lindquist CEO/Founder SonoPath.com
Thanks Eric. Good comments. I sent in a urine culture yesterday. But as I had mentioned…the bladder wall is now (2 weeks later) sonographically normal! Go figure. If this cat’s cystitis persists or recurs despite current therapy, then I will pursue a urinary bladder biopsy (to include any anatomical abnormality visualized and C&S).
So to my earlier point…is CF helpful in distinguishing mineral from a scar/fibrous finding in other tissues?
For example:
I have difficulty telling whether or not prostatic mineralization is present. The hyperechoic foci does not shadow well (for me:). Has anyone used CF to confirm a sparkling affect from a mineralized prostatic parenchyma?
Another example: Dystrophic renal tissue mineralization vs. Fibrosis associated with chronic renal disease (such as chronic interstitial nephritis). This may have been discussed previously.
@Eric Lindquist CEO/Founder
@Eric Lindquist CEO/Founder SonoPath.com
Thanks Eric. Good comments. I sent in a urine culture yesterday. But as I had mentioned…the bladder wall is now (2 weeks later) sonographically normal! Go figure. If this cat’s cystitis persists or recurs despite current therapy, then I will pursue a urinary bladder biopsy (to include any anatomical abnormality visualized and C&S).
So to my earlier point…is CF helpful in distinguishing mineral from a scar/fibrous finding in other tissues?
For example:
I have difficulty telling whether or not prostatic mineralization is present. The hyperechoic foci does not shadow well (for me:). Has anyone used CF to confirm a sparkling affect from a mineralized prostatic parenchyma?
Another example: Dystrophic renal tissue mineralization vs. Fibrosis associated with chronic renal disease (such as chronic interstitial nephritis). This may have been discussed previously.
Mineralization will usually
Mineralization will usually shadow to some extent, fibrosis only hyperechoic but fibrosis will undergo dystrophic mineralization. re prostate in a NM if its enlarged and mineralized it needs a needle no matter what doppler says.
I think maybe highly sensitive doppler/power doppler on high end machines may help here but don;t know if the sensitivity is solid enough in helping much other than a global aspect to the tissue.
re the cat bladder yes i have seen this come and go too especially sandy bladders there one day gone the next. best to always drop a prove right before sx to know what to expect.
regarding the sparkling effect I don’t know i the sparkling effect is consistent enough to draw a firm conclusion as top mineralization vs mucous vs scar tissue. We can start looking at it though now that you brought it up.
thx for the great info and Q
Mineralization will usually
Mineralization will usually shadow to some extent, fibrosis only hyperechoic but fibrosis will undergo dystrophic mineralization. re prostate in a NM if its enlarged and mineralized it needs a needle no matter what doppler says.
I think maybe highly sensitive doppler/power doppler on high end machines may help here but don;t know if the sensitivity is solid enough in helping much other than a global aspect to the tissue.
re the cat bladder yes i have seen this come and go too especially sandy bladders there one day gone the next. best to always drop a prove right before sx to know what to expect.
regarding the sparkling effect I don’t know i the sparkling effect is consistent enough to draw a firm conclusion as top mineralization vs mucous vs scar tissue. We can start looking at it though now that you brought it up.
thx for the great info and Q
I know this topic is old, but
I know this topic is old, but I will weigh in. This sparkling artifact Tom is referring to is a useful artifact to confirm mineral in a bladder…but it requires a machine that has good enough color doppler. My old machine could almost never do this and when I upgraded to the MyLab Alpha, it does it very consistently on all mineral sediment in the bladder. I have used it many times as confirmation of artifact. I don’t know for sure, but I think that part of what makes the artifact involves through transmission in fluid and thus it may not work in parenchyma like a prostate. Having said that, I haven’t tried it and will on the next one I see and report back…
I wanted to post some clips from a recent case on this subject, but I’m only able to post still images and so I will start a new discussion about this phenomenon and an example case we recently had where this artifact came in handy.
I can confirm that I get NO
I can confirm that I get NO sparkling artifact in the prostate with mineralization. Had a prostatic neoplasia yesterday and tried both with the microconvex, linear in color and power doppler…no artifact. I am quite confident the through transmission of the bladder to the stones in the far field creates the artifact.
I know this topic is old, but
I know this topic is old, but I will weigh in. This sparkling artifact Tom is referring to is a useful artifact to confirm mineral in a bladder…but it requires a machine that has good enough color doppler. My old machine could almost never do this and when I upgraded to the MyLab Alpha, it does it very consistently on all mineral sediment in the bladder. I have used it many times as confirmation of artifact. I don’t know for sure, but I think that part of what makes the artifact involves through transmission in fluid and thus it may not work in parenchyma like a prostate. Having said that, I haven’t tried it and will on the next one I see and report back…
I wanted to post some clips from a recent case on this subject, but I’m only able to post still images and so I will start a new discussion about this phenomenon and an example case we recently had where this artifact came in handy.
I can confirm that I get NO
I can confirm that I get NO sparkling artifact in the prostate with mineralization. Had a prostatic neoplasia yesterday and tried both with the microconvex, linear in color and power doppler…no artifact. I am quite confident the through transmission of the bladder to the stones in the far field creates the artifact.