This is a 7 year old FS Shitzu. She has a hx of hematuria w/ a urine SpG of 1.037, pH 8, some struvites seen, no bacteria, RBCs+++, few WBCs. Main question – looks like amorphous uroliths, but why is it taking up color flow? Last video in standing and does show material moving more to center
This is a 7 year old FS Shitzu. She has a hx of hematuria w/ a urine SpG of 1.037, pH 8, some struvites seen, no bacteria, RBCs+++, few WBCs. Main question – looks like amorphous uroliths, but why is it taking up color flow? Last video in standing and does show material moving more to center
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OK – Ill take a shot at this.
OK – Ill take a shot at this. The uroliths should not pick up color flow. I suspect the bladder is collapsed and you are picking up flow from the bladder wall or possibly the colon.
This is called twinkling
This is called twinkling artificat when there are multlipe tiny crystals embedded in the tissue. Usually a sign of severe encrusting cystitis.
Jacquie
Thanks Jacquie – I did not
Thanks Jacquie – I did not know this. Is the artifact coming from the crystals or the tissue in which the crystals are embedded.
I believe it is the crystals
I believe it is the crystals themselves and how they are spaced and sized within the tissue that creates the artificat seen.
Thank you for the reply! So
Thank you for the reply! So the doppler flow is actully an artifact? My only concern with going forward with this assumption is that in some of my views, the hyperechoic material is in the middle of the lumen w/ the dorsal wall partially visible below (instead of having the hyperechoic material adhered to the wall).
Hi Dr. Pankatz – could you
Hi Dr. Pankatz – could you please comment on my post above? Thank you for your time.
Hello Kromero
Sorry I missed
Hello Kromero
Sorry I missed your question!
What you may be seeing is some mucus/inflammatory cells/blood strands with crystals suspended in the urine – this can look very hyperechoic and not uncommonly seen in severe cystitis. It could also be the way the ultrasound beam is cutting throught the bladder which may make the material look to be free floating but is in fact attached to a lateral wall. In your images, the bladder is quite empty – it is always better to evaluate with more urine present as sometimes things can look quite different in a distended urinary bladder. The challenge is, of course, dogs with cysitis do not allow their urinary bladders to fill as they are urinating all the time from the inflammation.
With struvite crystals, I would bet this dog has a bacterial infection, so best to culture the urine even if you don’t see bacteria on u/a. Also the key is to rescan at the completion of treatment, preferably with a full bladder, to see if the artifact goes away and to to see if there are any stones hidden in there or in the trigone or proximal urethra (and also tumours) that may have been missed with a collapsed bladder.
I hope this helps!
Jacquie
Thank you! Makes sense.
Thank you! Makes sense. Owner planning to rescan after completing antibiotics.
Great – post a follow-up if
Great – post a follow-up if you can.