10 year old M/N Miniature Schnauzer presented for bladder ultrasound.
Jan 12th – uroliths discovered, urine culture – no growth.
Jan 20th – uroliths removed.
Jan 27th – free catch UA culture (referral clinic could not get cysto sample due to temperament) due to persistent hematuria – Pseudomonas growth with some resistance, was tx with orbifloxacin x 7 days.
Feb 12th – reculture (free catch again) – Pseudomonas growth. NSF on radiographs.
Feb 19th – dog presented to me for bladder ultrasound. Cysto sample obtained for culture (pending).
10 year old M/N Miniature Schnauzer presented for bladder ultrasound.
Jan 12th – uroliths discovered, urine culture – no growth.
Jan 20th – uroliths removed.
Jan 27th – free catch UA culture (referral clinic could not get cysto sample due to temperament) due to persistent hematuria – Pseudomonas growth with some resistance, was tx with orbifloxacin x 7 days.
Feb 12th – reculture (free catch again) – Pseudomonas growth. NSF on radiographs.
Feb 19th – dog presented to me for bladder ultrasound. Cysto sample obtained for culture (pending).
Attached video clips. Here is what I see:
-1 – bladder was maximally filled for study (>12 hrs since last peed!)
-2 – mucosal irregularity of apex consistent with recent sx.
-3 – hyperechoic non-shadowing areas “within” bladder wall consistent with suture line.
-4 – hyperechoic linear object that appears to be within bladder lumen in the area of the suture line, that appears to be suspended when dog is standing. Is this suture? Are these clips convincing enough to explore surgically? Anything else I should be doing here?
Thanks!!
Jennifer
Comments
I don’t know what suture
I don’t know what suture looks like under ultrasound- but I do have some concerns. In the 2nd cine loop I see what may be small stones that shadow. The bladder wall irregularity is probably due to chronic cystitis. With a pseudomonas you are going to have to be very agressive and treat for IMO 4-6 weeks.
I am going to include a chronic cystitis protocol that EL posted.
Chronic UTI Protocol
I recommend Enrofloxacin (5 mg/kg SID PO) in late pm after urination to maximize urinary concentrations overnight. This assumes that culture supports this use. Repeat culture at 3-4 weeks and continue treatment at least 7-10 days post negative urinary sediment and negative culture. Note: Negative culture does not necessarily mean lack of UTI. Other favorite antibiotics for chronic UTI include third generation Cefa (Ceftiafur or similar sid injectable) or Clavamox. If suspicion of occult urinary incontinence is present then phenylpropanolamine (PPA) (1-2 mg/kg BID) can be employed long term to enhance urethral tone.
Treatment for Pseudomonas usually requires a higher dosage than listed above.
Just my opinion- we can wait for other to weigh in on this.
Hello,
Thanks for the reply.
Hello,
Thanks for the reply. I also wondered about that area, but wondered whether it could be an accumulation of suture?
Jennifer
I don’t know what suture
I don’t know what suture looks like under ultrasound- but I do have some concerns. In the 2nd cine loop I see what may be small stones that shadow. The bladder wall irregularity is probably due to chronic cystitis. With a pseudomonas you are going to have to be very agressive and treat for IMO 4-6 weeks.
I am going to include a chronic cystitis protocol that EL posted.
Chronic UTI Protocol
I recommend Enrofloxacin (5 mg/kg SID PO) in late pm after urination to maximize urinary concentrations overnight. This assumes that culture supports this use. Repeat culture at 3-4 weeks and continue treatment at least 7-10 days post negative urinary sediment and negative culture. Note: Negative culture does not necessarily mean lack of UTI. Other favorite antibiotics for chronic UTI include third generation Cefa (Ceftiafur or similar sid injectable) or Clavamox. If suspicion of occult urinary incontinence is present then phenylpropanolamine (PPA) (1-2 mg/kg BID) can be employed long term to enhance urethral tone.
Treatment for Pseudomonas usually requires a higher dosage than listed above.
Just my opinion- we can wait for other to weigh in on this.
Hello,
Thanks for the reply.
Hello,
Thanks for the reply. I also wondered about that area, but wondered whether it could be an accumulation of suture?
Jennifer
The mural echogenic lesion
The mural echogenic lesion can certainly be suture but emerging tcc possible with the mineralizing polyps need to watch and tx chronic uti for now
Thanks for the reply!
So at
Thanks for the reply!
So at this point, would you just tx for 3 weeks with ABs then recheck bladder to see whether that area has progressed or regressed and surgically explore if not resolved (with biopsies obviously)? Referring vet is quite experience and neither of us have ever encountered this situation before… How long do you typically see suture line after cystotomy?
Thanks
Jennifer
The mural echogenic lesion
The mural echogenic lesion can certainly be suture but emerging tcc possible with the mineralizing polyps need to watch and tx chronic uti for now
Thanks for the reply!
So at
Thanks for the reply!
So at this point, would you just tx for 3 weeks with ABs then recheck bladder to see whether that area has progressed or regressed and surgically explore if not resolved (with biopsies obviously)? Referring vet is quite experience and neither of us have ever encountered this situation before… How long do you typically see suture line after cystotomy?
Thanks
Jennifer
It really depends oin the
It really depends oin the suture type and how th etissue reacts… this appears buried and walled off but wihtout an active inflammatory pattern with the suture itself and may have just fibrosed in the wall which creates the echogenicity.
Update – no growth on
Update – no growth on culture!
So…now I’m kind of confused… Obviously the pseudomonas is not bladder related – more likely repro tract (prostate imaged WNLs)… So what do I do about the suspected suture that appears inside the bladder? Would you just recheck bladder in a month?
Thanks
Jennifer
It really depends oin the
It really depends oin the suture type and how th etissue reacts… this appears buried and walled off but wihtout an active inflammatory pattern with the suture itself and may have just fibrosed in the wall which creates the echogenicity.
Update – no growth on
Update – no growth on culture!
So…now I’m kind of confused… Obviously the pseudomonas is not bladder related – more likely repro tract (prostate imaged WNLs)… So what do I do about the suspected suture that appears inside the bladder? Would you just recheck bladder in a month?
Thanks
Jennifer
UPDATE!
Dog was treated with
UPDATE!
Dog was treated with ABs for 3 weeks despite negative culture last time. Dog has hematuria again (owner isn’t sure if it ever went away).
Ultrasounded today – essentially looks the same as last time…so I guess that rules out suture, and makes cancer a more likely dx. Do you ever get these polypoid growths murally secondary to chronic UTIs/sx?
Also had one more (stupid) question – what is the anechoic tubular structure (dorsal) between the bladder and the colon (no CF)? Ureter? I looked at previous post and noticed it was there too…
Current plan – culture pending, will attempt to get ultrasound-guided biopsy (catheterized biopsy) of mural lesions and submit in red and purple top for culture and cytology. Does that sound reasonable? Would you do anything else?
Thanks!
Jenn
UPDATE!
Dog was treated with
UPDATE!
Dog was treated with ABs for 3 weeks despite negative culture last time. Dog has hematuria again (owner isn’t sure if it ever went away).
Ultrasounded today – essentially looks the same as last time…so I guess that rules out suture, and makes cancer a more likely dx. Do you ever get these polypoid growths murally secondary to chronic UTIs/sx?
Also had one more (stupid) question – what is the anechoic tubular structure (dorsal) between the bladder and the colon (no CF)? Ureter? I looked at previous post and noticed it was there too…
Current plan – culture pending, will attempt to get ultrasound-guided biopsy (catheterized biopsy) of mural lesions and submit in red and purple top for culture and cytology. Does that sound reasonable? Would you do anything else?
Thanks!
Jenn
Actually I would go in and
Actually I would go in and resect out the crnail 1/3 of the bladder and hope u get chronic polypoid cystitis and dystrophic mineralization instead of TCC. The mineralization pattern is odd for TCC though of course still considered. Regardless these lesions pose a point of nidus for infection and irritation and stioll apical dorsal so sx would be my choice here… when is doubt cut it out if you can. The hyperechoic line you refer to (if i have this right-arrow) is likely thickened serosal layer from siurgery combined wiht high gain on your settings.
Actually I would go in and
Actually I would go in and resect out the crnail 1/3 of the bladder and hope u get chronic polypoid cystitis and dystrophic mineralization instead of TCC. The mineralization pattern is odd for TCC though of course still considered. Regardless these lesions pose a point of nidus for infection and irritation and stioll apical dorsal so sx would be my choice here… when is doubt cut it out if you can. The hyperechoic line you refer to (if i have this right-arrow) is likely thickened serosal layer from siurgery combined wiht high gain on your settings.
Hello,
Thanks for the
Hello,
Thanks for the response.
The hyperechoic line I was referring to is actually the hyperechoic line that seems “attached” to the mucosal surface and is floating in the lumen.
Thanks again. I will let you know why they find!
Jennifer
Hello,
Thanks for the
Hello,
Thanks for the response.
The hyperechoic line I was referring to is actually the hyperechoic line that seems “attached” to the mucosal surface and is floating in the lumen.
Thanks again. I will let you know why they find!
Jennifer
OH right those are “ghosts”
OH right those are “ghosts” that are floating debris. Very common especially in cats
OH right those are “ghosts”
OH right those are “ghosts” that are floating debris. Very common especially in cats