Radiology3- Urinary Bladder

  1. Describe the location of the bladder in dogs and cats.
    • canine- may be partially intra-pelvic
    • feline- should always be intra-abdominal
  2. What are reasons for lack of visualization of the urinary bladder on rads? (3)
    • lack of distention
    • superimposition of intestines
    • decreased abdominal serosal detail
  3. Describe the use of compression to visualize the bladder.
    • compress laterally in front of hind legs
    • move intestines out of the way
    • decreases thickness of the patient--> less scatter
  4. What are causes of decreased opacity of the bladder? (2)
    • iatrogenic (cysto)
    • emphysematous cystitis
  5. What are causes of increased opacity of the bladder? (3)
    • calculi
    • sand-like material
    • dystrophic mineralization (mass- neoplasia, granulomatous disease, bladder wall itself)
  6. What types of calculi are radiopaque? (3)
    • silica
    • calcium oxalate
    • triple phosphate
  7. What are the radiolucent calculi? (2)
    • urate
    • cysteine
  8. What are general indications for contrast cystography? (4)
    • dysuria
    • pollakiuria
    • hematuria
    • changes on survey radiographs
  9. What types of contrast is used in contrast cystography?
    • positive- iodinated
    • negative- CO2 or NO
    • double- iodinated plus CO2 or NO
  10. What views are required for contrast cystography?
    • lateral
    • VD
    • ventral left- dorsal right oblique
    • ventral right- dorsal left oblique
    • [obliques are the get the bladder off the spine so we can see it better]
  11. What is the rule of thumb for how much contrast to instill in the bladder during a cystogram?
    stop when the bladder palpates distended and/or feel bak pressure on syringe plunger (don't rupture the bladder!)
  12. General indications for a POSITIVE contrast cystogram? (3)
    • locate the bladder (when not seen on surveys)
    • bladder tears
    • abnormal communications with bladder and ureters/ other organs
  13. What are indications for a DOUBLE contrast cystogram? (2)
    • intra-luminal filling defects
    • bladder wall lesions
  14. What is the techniques for double contrast cystogram?
    • small amount of iodinated contrast, roll patient to disperse contrast
    • then put in negative contrast to blow up the bladder
  15. What are potential complications of cystography? (3)
    • catheterization- trauma, bacterial introduction, kinking catheter
    • intramural/ subserosal accumulation of contrast
    • gas embolus (if gross hematuria is present)- this is why we don't use room air
  16. What are some mucosal changes that might be seen on cystogram? (3)
    • irregularity (may be normal if incompletely distended bladder)
    • mucosal proliferation d/t cystitis
    • ulceration
  17. How might bladder wall thickening due to neoplasia appear on cystogram? (3)
    • intra-mural filling defects
    • smooth or irregular mucosal surface
    • usually near the trigone
  18. How might bladder wall thickening due to cystitis appear on cystogram? (2)
    • smooth or irregular mucosal surface
    • usually at apex
  19. How do you know you're probably looking at gas bubbles on a cytogram and not calculi? (4)
    • bubbles are drawn to the edge of the contrast pool
    • well-defined filling defects
    • smoothly margined
    • will deform margins if next to each other
  20. How do calculi appear on cystogram? (4)
    • centrally located in contrast pool (unless adhered to bladder wall)
    • well-defined filling defects
    • smooth or irregular margins
    • radiolucent when surrounded by positive contrast (regardless of initial opacity on survey radiographs)
  21. How do blood clots appear on cystogram? (2)
    • filling defectsthat are poorly defined
    • irregular margins
  22. Describe the technique for bladder US.
    highest frequency possible (may be lower in large dogs)
  23. How does emphysematous cystitis appear on US?
    diffuse reverberation artifact originating from bladder wall causing shadow all over the entire screen- NOT HELPFUL, go to rads
  24. What is side lobe artifact and how do you make sure it's artifact and not pathology?
    • created by echo off nearby colon
    • look at longitudinal and transverse planes and see if it's still there
  25. What is the psuedosluge artifact on US and how do you ensure its artifact?
    • volume averaging of ventral aspect of the badder, making it look thicker
    • US is catching parts of the curve of the bladder
    • turn the probe transversely
  26. How do calculi appear on US?
    calculi are echogenic, MOVEABLE structures (rarely, stuck to bladder wall)
  27. How might chronic cystitis appear on US?
    • wall thickening usually cranioventrally
    • may be smooth or irregular
    • DDx neoplasia
Card Set
Radiology3- Urinary Bladder
vetmed radiology3