– 6 year MN DSH BCS 4/5 presented for an acute onset of dysuria, stranguria
– on physical exam he was stable, hydrated but had large, hard palpable urinary bladder (felt blocked)
– he had urinated on the owner on the way to the clinic and passed urine after I palpated the bladder but not a good stream and did not empty his bladder
– u/a showed RBC’s, +++ struvite crystals USG 1.050
– u/s of both kidneys normal, no uroliths in the ub however the proximal urethra was dilated and showed some hyperechoic densities that were non-shadowing
– 6 year MN DSH BCS 4/5 presented for an acute onset of dysuria, stranguria
– on physical exam he was stable, hydrated but had large, hard palpable urinary bladder (felt blocked)
– he had urinated on the owner on the way to the clinic and passed urine after I palpated the bladder but not a good stream and did not empty his bladder
– u/a showed RBC’s, +++ struvite crystals USG 1.050
– u/s of both kidneys normal, no uroliths in the ub however the proximal urethra was dilated and showed some hyperechoic densities that were non-shadowing
– Doppler colour flow hard to evaluate due to movement artifact
– cystocentesis performed and submitted urine for culture – drained off 200ml to increase comfort
– started patient on Convenia, gave a Metacam injection, oral phenoxybenzamine, 200ml SQ fluids and RC SO ph Control moist food – warned owner about complete blocking and to watch for this which will need more aggressive treatment (urinary catheter, bladder flush etc)
I highly suspect this is a typical FUS cat but the “stuff” in the proximal urethra looked a little strange to me. Could this just be mucus/blood clots with some crystals in it or should I be suspicious of a mass? My plan is to rescan this pet when better to see if it is still there.
Comments
The urethra is dilated
The urethra is dilated from distal obstruction. There is free fluid outside the urethra CUJ creating artifact and echogenic fat overlying the urethra and some minor mucous within the urethra I believe. The pelvic fat may be inflamed acusing that irregularity of the fat as well. When a bladder is distended for a long time the poressure gradient on the bladder wall will allow some passage of urine into the abdomen but urethral rent can do this too. Keep an eye on it and I would place a u cath and keep him empty for a few days and check that fluid accumulation daily as it should be diminishing.
Rule of thumb you have to be a cat that has lived a good life to get a bladder tumor (TCC) with exception of bladder lymphoma which is a zebra. Old cats get tumors younger cats get interstitial cystitis that can mimick a tumor. Check the sonopath basic search for feline bladder tumor and you will see what I mean… all geriatric … I think the youngest I have seen a TCC in a cat was 10 years but most are older.
http://sonopath.com/members/case-studies/search
The urethra is dilated
The urethra is dilated from distal obstruction. There is free fluid outside the urethra CUJ creating artifact and echogenic fat overlying the urethra and some minor mucous within the urethra I believe. The pelvic fat may be inflamed acusing that irregularity of the fat as well. When a bladder is distended for a long time the poressure gradient on the bladder wall will allow some passage of urine into the abdomen but urethral rent can do this too. Keep an eye on it and I would place a u cath and keep him empty for a few days and check that fluid accumulation daily as it should be diminishing.
Rule of thumb you have to be a cat that has lived a good life to get a bladder tumor (TCC) with exception of bladder lymphoma which is a zebra. Old cats get tumors younger cats get interstitial cystitis that can mimick a tumor. Check the sonopath basic search for feline bladder tumor and you will see what I mean… all geriatric … I think the youngest I have seen a TCC in a cat was 10 years but most are older.
http://sonopath.com/members/case-studies/search
Thanks for pointing that out.
Thanks for pointing that out. I thought I could see the urinary bladder wall traveling through the area but just wasn’t sure – it just looked very odd to me. Makes sense that this distended bladder would be leaky. Now I’ll know next time I see this again! Will definitely follow via ultrasound.
Thanks for pointing that out.
Thanks for pointing that out. I thought I could see the urinary bladder wall traveling through the area but just wasn’t sure – it just looked very odd to me. Makes sense that this distended bladder would be leaky. Now I’ll know next time I see this again! Will definitely follow via ultrasound.