proton vet Archives

Intestinal perforation with associated peritonitis in a dog

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

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).

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).

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.

Dorsal, sagittal and transverse planes

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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Very severe chronic otitis with severe diffuse hyperplasia in a dog

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

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.

Transverse and dorsal planes

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).

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).

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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Pulmonary carcinoma with metastasis in a cat

9-years-old, domestic long-haired cat. Presented for weight loss, decreased appetite, lethargy, with elevated respiration rate and coughing episodes. A thoracic CT-scan was performed.

Description

There is a mass like lesion, with irregular and ill-defined margins affecting the entire right accessory lung lobe and infiltrating the left caudal lung lobe (red arrows). This lesion has soft tissue attenuation, showing a slightly heterogeneous contrast enhancement. The lesion is visible as a consolidated area with presence of multiple air bronchograms embedded within the lesion, causing a mild mass effect over the lobar bronchi of the left caudal lung lobe, which is laterally displaced.

From left to right: pre and post-contrast images

In addition, the right middle and caudal lung lobes (blue and pink arrows respectively) are completely consolidated, with a slightly increased volume and presence of air bronchograms, with similar appearance compared to the previously described lesion. Cranial to this region, there is a subpleural lesion connecting with the right caudal lung lobe, which seems to infiltrate the caudal aspect of the right cranial lung lobe (yellow arrows). These lung lobes have a soft tissue attenuation with a mild and slightly heterogeneous contrast enhancement.

In addition, at the aerated portions of the left caudal lung lobe, there are multiple, variable in size, ill-defined nodular lesions (pink arrows).

There is a moderate/marked enlargement of the tracheobronchial lymph nodes (green arrows), which show a reduced homogeneous contrast enhancement.

Diagnosis

Complete consolidation of the right middle, caudal and accessory lung lobes associated to a mass-like lesion, partially infiltrating as well the left caudal lung lobe and possibly the right cranial lung lobe. These findings are most likely consistent with a neoplastic process (primary pulmonary tumor – carcinoma, among others).
At least 3 small nodules in the left caudal lung lobe, adjacent to the previously described lesion, consistent with metastatic disease, most likely.
Moderate tracheobronchial lymphadenopathy, most likely metastatic.

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