Abdominal radiograph - opinions please!

Re: Abdominal radiograph - opinions please!

Lorna McHardy — Tue, 07 Feb 2012 11:02:17 GMT

abdominal ventilation

Re: Abdominal radiograph - opinions please!

derrick carpenter — Tue, 07 Feb 2012 08:52:28 GMT

also know as releasing the evil spirits

Re: Abdominal radiograph - opinions please!

james herriot lied — Mon, 06 Feb 2012 22:44:57 GMT

Peritoneal Aeration. Works. Every. Time.

Re: Abdominal radiograph - opinions please!

Iain McAllister — Sun, 05 Feb 2012 21:55:54 GMT

...for those following pet in question seems to be going on well!

Re: Abdominal radiograph - opinions please!

Laurence Webb — Wed, 01 Feb 2012 18:43:13 GMT

[quote user="Mark Holmes"]Yes but we don't know the shape of the piece of bone. The recent that area is lucent could be due to its absence[/quote]My immediate thought on seeing the radiograph was that it was half a vertabra from a pork chop - the lucent area being the spinal canal. If it has been bathed in acid for a day or two it would decalcify a bit.

Re: Abdominal radiograph - opinions please!

Bob Russell — Wed, 01 Feb 2012 17:29:32 GMT

[quote user="james herriot lied"]

[quote user="Bob Russell"]

[/quote]

Erm.....

My understanding is that it's Iain's place of work which is the OOH centre. Lest we start to chuck some huge bricks, perhaps we shouldn't be frightening the poor bloke so. Iain, how does the land then lie in terms of offering follow-up? Are you able to do this, or is the client's own practice going to be needing to offer it?

[/quote]

Suitably modified my post in case I have frightened anyone! I hate these cases that are not going to plan and will phone a certain number for reassurance which so far has always been forthcoming!

No more comments from me until a diagnosis has been reached!

Re: Abdominal radiograph - opinions please!

Mark Holmes — Wed, 01 Feb 2012 17:26:19 GMT

[quote user="James Laidlaw"]

[quote user="Mark Holmes"]

[quote user="James Laidlaw"]I'm gonna go out on a limb and say maybe this is a little over-cropped to get a good impression, but is it lacking too much in the way of density to be a bone. As someone pointed out, there's a loop of intestine and gas showing through it and it's not over-riding the gas density[/quote]

I wouldn't completely agree with this, you can still see gas shadows overlying the vertebrae if you take a DV and your settings are right and the object is a similar density to the ribs in the top right. Obviously some of the rib is cartilage but the head of the rib is visable in the extreme top right corner.

[/quote]

True, but I think in this case it doesn't look so much like a gas shadow over bone as an almost completely radiolucent area running through the region in question whereby the "bony" density of the surrounding area in question appears to be completely absent. Surely the density of BONE wouldn't be affected this much by overlying gas and soft tissue?

[/quote]

Yes but we don't know the shape of the piece of bone. The recent that area is lucent could be due to its absence. Quite how an unknown 3d irregular object will appear on a 2d radiograph and interact with the various overlapping soft tissue and gas shadows is surely almost impossibe to interpret in the fine detail. The bulk of the object approximates to bone density relative to other boney structures on the radiograph, its a dog and dogs eat bones. Surely any other interpretation is a zebra diagnosis until proven otherwise?

Re: Abdominal radiograph - opinions please!

James Laidlaw — Wed, 01 Feb 2012 17:04:48 GMT

[quote user="Mark Holmes"]

[/quote]

Re: Abdominal radiograph - opinions please!

james herriot lied — Wed, 01 Feb 2012 16:06:30 GMT

[quote user="Bob Russell"]

Then a phone call to VDS may indeed be in order.

[/quote]

Erm.....

Re: Abdominal radiograph - opinions please!

Bob Russell — Wed, 01 Feb 2012 15:47:33 GMT

Time for a follow up set of X-rays (at least) methinks!

Re: Abdominal radiograph - opinions please!

Gerry Henry — Wed, 01 Feb 2012 15:34:37 GMT

Ex Lap at OOH clinic and now a post op temp of 106, FFS!

I hope somebody paid their VDS subs.

Re: Abdominal radiograph - opinions please!

Iain McAllister — Wed, 01 Feb 2012 15:30:05 GMT

Can see this is dividing opinion...some good learning points tho

- end result still not known as ex-lap was done at emergency clinic and now back at own vets - am in contact with them so will update on what happens

- is eating and drinking now but temp is 106 (41.1 for anyone graduating after 2000 - I hate the demise of farenheit...but that's another post...)

cheers

Re: Abdominal radiograph - opinions please!

Mark Holmes — Wed, 01 Feb 2012 12:13:47 GMT

Re: Abdominal radiograph - opinions please!

James Laidlaw — Wed, 01 Feb 2012 11:19:47 GMT

I'm gonna go out on a limb and say maybe this is a little over-cropped to get a good impression, but is it lacking too much in the way of density to be a bone. As someone pointed out, there's a loop of intestine and gas showing through it and it's not over-riding the gas density. A bone wouldn't do this. Again, with all the x-rays that have been appearing lately, there's no dv view. If a bone is present - you will see it on both views and thus be able to localise it and confirm it is definitely there before opening up.

It's taken me nearly 9 years in practice, but I will routinely take 2 views of everything now (at least), because you just can't be certain enough on one view and there's a lot of information to be missed by only doing half the job.

Re: Abdominal radiograph - opinions please!

Hannah Wynne Richards — Wed, 01 Feb 2012 10:28:37 GMT

I wish my radiographic interpretations were that positive !!!!!!!!!!!!!!!!!!!!!!!!!!

Seriously I would have expected intersusception to have caused peritonitis which would be difficult to miss on ex lap-ileus also usually obvious as lack of normal peristaltic movements so I'm going with the bone in stomach crowd

Wynne

PS Now wait for us tobe proven wrong

Re: Abdominal radiograph - opinions please!

argyro koukouseli — Tue, 31 Jan 2012 21:27:55 GMT

its a caracteristic image of ileus-enteritis.the "fb" area is not bony-like to me,more like intussusception

Re: Abdominal radiograph - opinions please!

Bob Russell — Tue, 31 Jan 2012 09:33:03 GMT

Perhaps I am being a bit thick and a case of shutting the stable door after the horse has bolted but if nothing was found wouldn't a follow up quick X-ray have been in order before closing up?

I know it is very easy to be wise after the event but sometimes the only thing some cases can do is teach you lessons for next time!!

I suspect we have all been there and as Homer Simpson would say Doh!

Re: Abdominal radiograph - opinions please!

Iain McAllister — Tue, 31 Jan 2012 07:21:52 GMT

Thanks good advice given by all - will chat about re xray!

Re: Abdominal radiograph - opinions please!

james herriot lied — Mon, 30 Jan 2012 23:03:10 GMT

[quote user="Iain McAllister"]

re DV/VD you are right that would have been useful but colleague didn't take one

[/quote]

Well, I think we've all been there - and no doubt will again. The question now is whether good old peritoneal aeration has done the trick, and the dog goes on fine. It's unlikely that your colleague has missed a FB of this size on ex-lap - most of us have been around the block a bit and know where the little buggers hide.

But....... would it be a good idea to offer a FOC re-xray, just for your own peace of mind? You can dress it up how you want, but if the dog's reasonably quiet, you might even get away with a conscious rad, as the thing you're looking for isn't exactly subtle. Certainly, if the dog continues to vomit, it's going to be a difficult conversation with the owner: did you convince them that there was a strong likelihood of FB from the x-ray, prior to gaining consent for surgery? Again, we've all done that (at least, I have) and then found an empty abdo with a routine GE: I'd defend that one till the coes come home.

I'd also say that I rarely get to feel a stomach FB prior to surgery, even with the dog held vertically.

Re: Abdominal radiograph - opinions please!

Iain McAllister — Mon, 30 Jan 2012 22:45:09 GMT

I know what you mean but it looked so irregular and bone like - that type of FB rarely passes in my experience...

Re: Abdominal radiograph - opinions please!

Robin Grimmer — Mon, 30 Jan 2012 22:34:47 GMT

if it had only vomited once I wouldn't have gone for ex lap straight away, probably managed conservatively with i/v fluids +- laxatives

and re-xrayed to see if FB had moved.

Re: Abdominal radiograph - opinions please!

Mark Holmes — Mon, 30 Jan 2012 21:38:42 GMT

I reckon bone is sat in pylorus, when dog on its back the bone has then dropped into the cardia where they can be easy to miss unless you look specifically.

Re: Abdominal radiograph - opinions please!

Robin Grimmer — Mon, 30 Jan 2012 21:18:11 GMT

[quote user="Iain McAllister"]

re DV/VD you are right that would have been useful but colleague didn't take one - I was thought it was a bone too with the distinct edges but I wasn't present at the ex lap and nothing was found...

[/quote]

was it in the colon?

Re: Abdominal radiograph - opinions please!

KathW — Mon, 30 Jan 2012 21:12:38 GMT

Isn't there a gassy loop of Si going right through the middle of that and traceable before and after the density?

Re: Abdominal radiograph - opinions please!

Iain McAllister — Mon, 30 Jan 2012 20:43:19 GMT

Here is a close up