What’s Your Diagnosis? October – December Challenge Answer
A special thank you to Dr. Julie Breher of the La Jolla Veterinary Hospital for submitting this case.
This challenge involves a 13 year-old M/C Yorkie. The dog experienced vomiting and diarrhea for 3 days and decreased appetite for 3 days. There was splinting on abdominal palpation. Rectal exam confirmed diarrhea with a small amount of frank blood. Splenectomy was performed 3 years ago.
Orthogonal views of the thorax and abdomen are available below for interpretation.
There was no challenge winner this time.
Abd: The transverse and descending colon is gas filled and has a rigid appearance. The small bowel is diffusely fluid filled with intestinal diameter at the upper limits of normal. There is stippled mineralization associated with the gallbladder contents. There are multiple hemoclips in the left cranial abdomen consistent with historical splenectomy. Abdominal detail is wnl.
Conclusion:
1) Appearance to the gastrointestinal tract is most consistent with enteritis and colitis.
2) Gallbladder appearance likely represents small cholelits however biliary wall mineralization cannot be ruled out. Material in the pylorus is considered far less likely but a left lateral abdominal radiograph could be performed to confirm that this structure does not represent the pylorus.
The rigid appearance to the descending colon is a common finding in both dogs and cats with colitis. The thickened appearance to the colonic wall could represent true thickening, however it could also represent adhered mucus. That is why bowel wall thickness can only be measured accurately with ultrasound.
The appearance to the gallbladder was concerning to the clinician, but the lack of bilirubin elevation made an obstruction unlikely. Other considerations for the mineralization in this region include a mineralized liver mass or pylorus. The location makes gallbladder contents most likely. The size and slightly cranial location compared to the stomach makes the pylorus unlikely. However, if you are ever unsure about something being the pylorus, obtain a left lateral view.
This patient was treated supportively for colitis and improved over the next few days. No elevation in bilirubin has been reported.
