Case of the week 1.14.19
Publication Date: 2019-01-14
History
10 year old West Highland White Terrier Vomiting, inappetence for the last 2 months. Vomited 3 times in the last 30 minutes.
3 images
Quiz
- There are:No signs of mechanical obstruction.
:(Signs of partial mechanical obstruction
:-)Signs of mechanical obstruction
:-(
Findings
Abdominal serosal margin detail is normal. There is moderate to marked fluid and gas dilation of a small intestinal segment in the left mid to caudal ventral abdomen, partially superimposed with the descending colon. Numerous pinpoint mineral opacities are noted within this intestinal segment, best seen on the lateral views. The colon is diffusely fluid and gas distended and also contains a small amount of granular fecal material.
The stomach contains a small amount of gas and is minimally distended.
The liver is mildly enlarged, extending beyond the costal arch with a smooth, thickened caudoventral margins. The spleen, kidneys and urinary bladder are normal.
The included thoracic structures are normal.
Diagnosis
Segmental small intestinal dilation associated with a 'gravel sign' is consistent with chronic, at least partial, mechanical ileus. An underlying cause is not identified radiographically, however infiltrative neoplastic disease should be ruled out, and abdominal ultrasound is recommended for further evaluation.
Mild hepatomegaly is nonspecific and may represent a benign process (such as vacuolar hepatopathy), or diffuse neoplastic infiltration.
Discussion
On ultrasound there was: There is focal dilation of the small intestines adjacent to the ileocolic junction. At that level the intestinal segment contains a large amount of hyperechoic material with distal acoustic shadowing. Immediately adjacent there is a small intestinal segment which is thickened and has diffuse loss of wall layering. This is surrounded by mildly enlarged hypoechoic mesenteric lymph nodes. The surrounding mesentery is hyperechoic.
Diagnosis
FNAs of the instestinal wall and lymph nodes were consistent with lymphoma.