Reproductive Tract Imaging by gvl14091

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									   Imaging of the Reproductive
       System (+free air)
                      Dr. LeeAnn Pack
                      Diplomate ACVR


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        Pneumoperitoneum
• Etiologies
  – Penetrating external wound
     • Trauma
     • Iatrogenic
        – Abdominocentesis
        – Laparotomy - may persist for time after surgery
  – Rupture of internal viscous
     • Gastrointestinal tract most common
        – Most air originates from stomach and colon rupture
        Pneumoperitoneum
• Roentgen signs
  – Enhanced visceral/serosal margin detail
  – Visualization of abdominal structures not
    normally seen
  – Intra-abdominal gas opacities not
    conforming to or visualized within GI
    structures
    • Often looks like small little gas bubbles
      Improved Serosal Surface
• Surgery
               Detail
• Penetrating
  wound
• Bowel perforation
• Negative contrast
  cystogram with
  iatrogentic rupture
• Idiopathic
        Free Peritoneal Air

• Large to moderate
  volume
• Caudal surface of
  diaphragm
• Enhanced organ
  outline
        Pneumoperitoneum
• Diagnosis
  – Positional radiography = horizontal beam
    • Position animal to allow gas to accumulate in
      area where easily visualized
    • Take advantage of gravity to localize gas
       – Elevated Dorsal recumbency: accumulation of gas in
         area of liver, diaphragm, and falciform fat
       – Left lateral recumbency: accumulation of gas in right
         cranial quadrant away from fundus of stomach
           » Air seen against the liver
 Elevated Dorsal Recumbency




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    Vaginocystourethrogram
• General
  anesthesia
• Pelvic/vaginal
  mass, dysuria,
  hematuria,
  incontinence,
• Urethral
  stricture/tumor
                      Normal VCU
                                        Vagina




                                   Urethra




                         Bladder
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        Uterus and ovaries
• Normally radiographically invisible
• May see uterine body dorsal to bladder
  in obese animals
  – Compression (“spoon”) film
  – Use to detect mild uteromegaly
                 The uterus
•   Is the uterus normal?
•   Is the uterus enlarged?
•   Is there evidence of a pregnancy?
•   Are there signs of fetal death?
•   Is there a cause for dystocia?
       Uterine Enlargement
• Tubular structure that extends caudally
  into the pelvic canal
• Consider the following
  – Gravid or post-partum uterus
  – Pyometra, hydrometra, mucometra
  *clinical presentation will help distinguish
                    Uteromegaly
• Cranial and
  dorsal
  displacement of
  SI and colon
• Body between
  colon and
  bladder
• Coiled tubular
  structure
               Uteromegaly

• May be easier to
  see on VD - along
  flanks
• Medial displacement
  of SI from L&R
  – Characteristic of
    uteromegaly
                      Uteromegaly




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                      Gravid Uterus




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              Pyometra




-large tubular soft tissue
structures                 -marked abdominal distention
                           -large tubular structures
                      Pyometra




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                      Pyometra




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               Pregnancy
• Uteromegaly
• Fetal
  mineralization
  at d42-45
                      Pregnancy




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   Is It Going To Come Out???




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                     Dystocia
• Don’t forget
  when doing
  pregnancy
  check
• Stenosis of
  pelvic canal
   – Old fractures
• Fetal viability
                      Dystocia




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                   Fetal death
• Hyperflexed or
  hyperextended
• Collapsed
  skull bones
• Intrafetal or
  intrauterine
  gas
Note the Air in the Fetal Chest




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                Ovaries
• Small soft tissue structures within the
  peritoneal space
• Lie caudal to their respective kidney
• Not normally seen on survey films
           Ovarian Enlargement
- Soft tissue opacity caudal to the kidney
- Consider ovarian mass
               Testicles
• Intra-abdominal testicles
  – Anywhere between caudal pole of kidney
    and external inguinal canal
• Must be enlarged to be detected
               The Prostate
•   Is the prostate normal?
•   Is the prostate enlarged?
•   Is the shape normal or irregular?
•   Is there evidence of prostatic carcinoma?
        Prostate Gland
• Not visible radiographically in normal dogs
   –   Enlarges with age, especially if intact
   –   Look for the triangle to recognize
• Causes for enlargement
   –   Cysts
   –   Infection
   –   BPH
   –   Cancer
• Radiographic evidence of mineralization
   –   usually due to adenocarcinoma
                      Intact Male




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                      Intact Male




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          Prostatomegaly
• Dorsal
  displacement +/-
  compression of
  colon
• Cranial
  displacement of
  bladder
• Assess shape and
  opacity
            Prostatic Neoplasia
• Sub-lumbar lymph
  node enlargement
• Periosteal new bone
  last 2-3 L vertebrae                  Prostate
  and sacrum
                         Bladder   Triangle
• +/- Mineralization
      Prostatic Adenocarcinoma




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        Must Look for the Mineral




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           Prostatomegaly
• Focal loss of detail
  – Prostatitis and local peritonitis
  – Adenocarcinoma and local extension =
    carcinomatosis
MILD PROSTATOMEGALY
 Abdominal Lymph Nodes
• Normal Anatomy
  – Normal lymph nodes not seen radiographically
• Location
  – Medial Iliac & hypogastric (sub-lumbar)
  – Mesenteric
   Abdominal Lymph Nodes
• Location
  – Medial Iliac LN
    • Ventral to L6-L7-sacrum
    • Enlargement
       – Ventral displacement of colon
       – Increased soft tissue opacity in iliac region
          Lymph nodes

• MILNE
          Lymph nodes

• MILNE
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    Note the Colon is Displaced




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 Abdominal Lymph Nodes
• Location
  – Mesenteric LNN
    • Drainage of abdominal viscera
     (liver, spleen, pancreas, GI)
    • Enlargement
       – Central abdominal mass in area of root of
         mesentery displacing abdominal viscera
         peripherally and ventrally
               Lymph nodes
• Mesenteric
   Lymph Node Enlargement
• Associations
  – Lymphosarcoma
  – Neoplastic or inflammatory/infectious
    diseases of the pelvic canal (sublumbar)
    • Prostate
    • Urinary bladder
    • Uterus
  – Granulomatous disease

								
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