Intestinal perforation with associated peritonitis in a dog

2 year old miniature dachshund

2-years-old, Miniature Dachshund. Presented with vomiting and diarrhea, having lost a significant amount of weight. An abdominal CT-scan was performed.

2 year old miniature dachshund

Description

All the peritoneal fat is mildly diffusely increased in attenuation throughout the entire abdomen (orange arrows). There is a very mild amount of fluid attenuating non-contrast enhancing material spreading between the small intestine (blue arrows).

dog, CT, abdomen, intestine
dog, CT, abdomen, intestine
dog, CT, abdomen, intestine

At the most distal aspect of the descending duodenum/beginning of the jejunum (located at the level of the left mid-abdomen), there is a focal area of complete disruption of the intestinal wall, with a small hypoattenuating defect (orange arrows). This region connects with a fistulous tubular tract that extends along the peritoneum connecting the intestinal loop with the abdominal wall at the level of the left mid/caudal abdomen (red arrows) and connecting with a cavitated lesion that extends along the left abdominal wall and subcutaneous tissues (green arrows).

dog, CT, abdomen, duodenum and jejunum
dog, CT, abdomen, duodenum and jejunum

Saggital and transverse planes

The fistulous tract shows a thin soft tissue wall with homogeneous post-contrast enhancement, and it contains fluid attenuating, non-contrast enhancing material and gas. In addition, the fistulous tract seems to extend cranially located between the abdominal wall and the splenic tail finishing at the level of the cranial/mid-abdomen, immediately caudal to the last rib (blue arrows). In the left abdominal wall, there is a moderate diffuse thickening of the muscles of the wall. Between the muscles of the abdominal wall and extending into the subcutaneous tissue, extending from the region immediately caudal to the last rib up to the inguinal region, there is a cavitated lesion with irregular and ill-defined margins, containing fluid attenuating, non-contrast enhancing material and gas (green arrows). There is an area of disruption of the abdominal muscles connecting with the subcutaneous tissue within this lesion (pink arrows). There is no evident foreign material visible within the affected intestinal loop, fistulous tract or cavitated lesion in the abdominal wall/subcutaneous tissues.

dog, CT, abdomen, spleen
dog, CT, abdomen, spleen
dog, CT, abdomen, spleen

Dorsal, sagittal and transverse planes

dog, CT, abdomen, spleen
dog, CT, abdomen, spleen

Dorsal planes

Diagnosis

  • Changes at the most distal aspect of the descending duodenum/proximal jejunum, consistent with intestinal perforation with complete disruption of the intestinal wall, connecting with a fistulous tract that extends along the peritoneal cavity, connecting with the left abdominal wall. The intestinal perforation could be caused by a penetrating and migrating foreign material considering the history, even if the foreign material is not clearly visible on the CT vs penetrating wound caused by the foreign material.
  • The fistulous tract has a path that goes into the left abdominal wall and another branch, extending cranially between the abdominal wall and the spleen, finishing caudal to the last rib. Adherences with the spleen cannot be ruled out based on the CT.
  • Cavitated lesion affecting the left abdominal wall and adjacent subcutaneous tissues, extending from the caudal aspect of the last rib up to the left inguinal region, consistent with an abscess, containing gas and fluid. There is no evident foreign material, although this cannot be completely ruled out based on the CT.
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Chronic hepatitis with hepatic cirrhosis and portal hypertension in a dog

7-year-old mixed dog

7-years-old, mixed dog. Presented with vomiting, weight loss and decreased appetite. An abdominal CT-scan was performed.

7-year-old mixed dog

Description

The liver is severely reduced in size, with markedly rounded margins, especially on the left side. The left medial and lateral liver lobes are severely reduced in size, with rounded margins, and homogeneous pre- and post-contrast attenuation (orange arrows). The remaining liver lobes are also decreased in size, although less severely, with a nodular appearance, showing slightly heterogeneous soft tissue attenuation and post-contrast enhancement, with multiple ill-defined hypoattenuating areas (blue arrows).

dog, CT, abdomen, liver lobes
dog, CT, abdomen, liver lobes

The portal vein, at its extra and intrahepatic portions, and the hepatic veins are surrounded by a hypoattenuating halo/region, which is quite severe in the cranial abdomen and less severe in the remaining portions, consistent with severe perivascular oedema (green arrows). 

dog, CT, abdomen, portal vein
dog, CT, abdomen, portal vein
dog, CT, abdomen, hepatic and renal vessels

Adjacent to the hepatic vessels, in the left cranial abdomen, there is a small network of tortuous vessels, without being able to follow its path, consistent with gastroesophageal varices (purple arrows). In addition, there is a small network of tortuous vessels in the region surrounding the cranial mesenteric artery and renal vessels, medial to the left kidney, consistent with gastrophrenic varices (red arrows).

dog, CT, abdomen, hepatic and renal vessels
dog, CT, abdomen, hepatic and renal vessels

The pancreas is slightly prominent with a hypoattenuating halo and multiple hypoattenuating stripes consistent with pancreatic oedema (orange arrows).

dog, CT, abdomen, pancreas

Some of the mesenteric lymph nodes (hepatic, splenic and colic lymph nodes – blue, orange and green arrows respectively) are slightly prominent, decreased in attenuation and with reduced post-contrast enhancement

dog, CT, abdomen, mesenteric lymph nodes
dog, CT, abdomen, mesenteric lymph nodes
dog, CT, abdomen, mesenteric lymph nodes

There is a scant amount of peritoneal fluid surrounding the abdominal organs, visible between the intestinal loops (green arrows). In addition, the peritoneal fat has a diffusely and slightly increased attenuation, with presence of fat stranding (blue arrows).

dog, CT, abdomen, intestinal loops
dog, CT, abdomen, intestinal loops

Diagnosis

  • Severely reduced in size liver (left side>right) with nodular appearance, with rounded margins and areas of heterogeneous attenuation. These changes are most likely consistent with hepatic cirrhosis, most likely secondary to chronic hepatitis. Associated with these changes, there are changes consistent with portal hypertension:
    • Very severe perivascular oedema surrounding the portal vessels and hepatic vein.
    • Pancreatic and mesenteric oedema.
    • Presence of gastrophrenic and gastroesophageal varices, consistent with acquired portal collateral circulation.
    • Scant amount of peritoneal effusion.
  • Mild mesenteric lymphadenopathy, which could be reactive associated with the hepatic abnormalities vs edematous lymph nodes secondary to portal hypertension cannot be excluded.
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Very severe chronic otitis with severe diffuse hyperplasia in a dog

Bichon Frise

13-years-old, Bichon Frise. Presented with ceruminous adenoma and left chronic otitis externa. A CT-scan of the head was performed.

Bichon Frise

Description

There is a severe diffuse thickening of the wall of the left external ear canal. This thickening encircles the entire external ear canal at its vertical portion (orange arrows) causing a severe narrowing of the lumen that is visible as a small hypoattenuating line (blue arrows). At the horizontal portion of the external ear canal, there is a moderate focal expansion of the canal, with the thickening affecting mostly the ventral wall (pink arrows), and the lumen is filled with fluid-attenuating, non-contrast enhancing material (green arrows). In addition, there are multiple mineral attenuating foci at the wall of the external ear canal (yellow arrow). Despite the expansion of the external ear canal at its horizontal portion, the lesion in the canal does not invade the adjacent soft tissue structures.

dog, CT, head, left external ear canal
dog, CT, head, left external ear canal

Transverse and dorsal planes

dog, CT, head, left external ear canal
dog, CT, head, left external ear canal

Sagittal planes of the vertical and horizontal portions of the external ear canal.

The same material visible in the lumen of the external ear canal extends into the tympanic bulla, partially occupying its lumen (orange arrows). Otherwise, the left tympanic bulla has normal shape and wall (blue arrows).

dog, CT, head, tympanic bulla
dog, CT, head, tympanic bulla

The wall of the right external ear canal is mildly diffusely thickened (blue arrows), showing homogeneous post-contrast enhancement, with multiple small mineralizations (orange arrows).

dog, CT, head, right external ear canal

Diagnosis

  • Changes in the left external ear canal are consistent with a very severe chronic otitis externa, with the changes in the wall consistent with severe diffuse hyperplasia of the wall of the canal +/- concurrent ceruminous adenoma. Considering the expansion of the horizontal portion of the canal, an incipient malignant process (carcinoma) cannot be excluded, although considered unlikely since there is no evident invasion of the adjacent tissues.
  • Extension of the content of the external ear canal into the left tympanic bulla, consistent with left otitis media.
  • Mild thickening of the wall of the right external ear canal, without signs of secretion, most likely consistent with degenerative changes secondary to previous otitis externa without evident signs of active infection.
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Thyroid carcinoma with severe pulmonary metastasis in a dog.

7-years-old, French Bulldog. Respiration improved after BOAS surgery, but recently has become noisier. A CT-scan of head, neck and thorax was performed.

Description

In the right cranial cervical region, there is a soft tissue attenuating mass with heterogeneous attenuation, showing marked heterogeneous post-contrast enhancement (red arrows), located in the anatomical location of the right thyroid, which is not visible. The mass is highly infiltrative, with ill-defined margins.

dog, neck, cervical
dog, neck, cervical
dog, neck, cervical
dog, neck, cervical

The mass severely invades the adjacent soft tissues invading the cranial trachea (pink arrows), the laryngeal wall (purple arrows) and the wall of the cranial esophageal sphincter (blue arrows).

dog, neck, trachea, larynx, oesophagus
dog, neck, trachea, larynx, oesophagus
dog, neck, trachea, larynx, oesophagus
dog, neck, trachea, larynx, oesophagus

The right retropharyngeal lymph node is severely enlarged with homogeneous post-contrast enhancement (blue arrows).

dog, neck, lymph nodes
dog, neck, lymph nodes

In the thorax there is a thrombus that extends along the cranial vena cava slightly invading the right atrium (red arrows).

dog, thorax, vena cava, right atrium

There are several small soft tissue nodules, with well-defined margins, spread throughout the lung parenchyma. They show marked heterogeneous post-contrast enhancement.

dog, thorax, lung parenchyma
dog, thorax, lung parenchyma
dog, thorax, lung parenchyma
dog, thorax, lung parenchyma

Diagnosis

  • Large mass highly infiltrative with aggressive characteristics located in the right cranial cervical region at the anatomical location of the right thyroid, consistent with a neoplastic process (infiltrative thyroid carcinoma, most likely).
  • Marked right retropharyngeal lymphadenopathy, consistent with metastasis.
  • Multiple pulmonary nodules, consistent with severe pulmonary metastasis.
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Lobar pneumonia with abscess caused by inhalation of a foreign body in a dog.

2-years-old, mixed breed dog. Presented for coughing episodes and suspected abscess caused by foreign body. A thoracic CT-scan was performed.

Description

The accessory lung lobe is almost entirely consolidated, being increased in attenuation with presence of an air bronchogram at its dorsal and medial aspect and a cavitary lesion at its ventral aspect. The area of alveolar pattern shows a slightly heterogeneous enhancement (blue arrows). The cavitary lesion presents multiple cavities within it that appear to be connected with each other, with fluid attenuating, non-contrast enhancing material and multiple gas bubbles, being surrounded by a thick capsule that shows marked post-contrast enhancement (red arrows). These lesions are in close contact with the diaphragm and with the cardiac silhouette in the region adjacent to the left ventricle. The caudal vena cava (CVC) is located to the right of the consolidated lobe, in intimate contact with the area of alveolar pattern, without being in contact with the cavitary lesion or involved in it.

dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe

In the left caudal lung lobe, there is a focal and tubular bronchiectasis of the lobar bronchus up to its most peripheral aspect (blue arrows) with the bronchus correctly aerated. In its more peripheral aspect, at the most caudodorsal aspect of the lung lobe, associated to the area of bronchiectasis, there is a focal area with slightly ill-defined margins, increased attenuation (pink arrows) associated with a pleural band (orange arrows), causing a small indentation on the surface of the lung lobe.

dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe

In the left caudal lung lobe, there is a focal and tubular bronchiectasis of the lobar bronchus up to its most peripheral aspect (blue arrows) with the bronchus correctly aerated. In its more peripheral aspect, at the most caudodorsal aspect of the lung lobe, associated to the area of bronchiectasis, there is a focal area with slightly ill-defined margins, increased attenuation (pink arrows) associated with a pleural band (orange arrows), causing a small indentation on the surface of the lung lobe.

dog, CT, thorax, lymph nodes
dog, CT, thorax, lymph nodes
dog, CT, thorax, lymph nodes

Diagnosis

  • Alterations in the right accessory lung lobe consistent with lobar pneumonia and abscess most likely associated with inhaled foreign body, even if the foreign body is not clearly visible in the CT. Consider that, given that the lesion consistent with an abscess is in intimate contact with the diaphragm and the cardiac silhouette, the presence of adhesions in these structures cannot be ruled out.
  • Alterations in the left caudal lung lobe, at its caudodorsal aspect, consistent with pneumonic focus with pleural adhesion and bronchiectasis of the main bronchus, associated with migration of the inhaled foreign body.
  • Mild sternal and tracheobronchial lymphadenopathy, most likely reactive.
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