WILLOUGHBY’S POSITIVE-CONTRAST

CYSTOGRAPHYADV. RADIOLOGY AND IMAGING SPRING ’15

AMANDA LAFFOONTARLETON STATE UNIVERSITY

TABLE OF CONTENTS• History

• Assessment

• Survey Radiographs

• Positive-Contrast Cystography

• Sedation and Supplies

• Procedure

• Findings

• Surgical Intervention & Recovery

• References

HISTORY

• Willoughby is a 10 month old spayed female Cavalier King Charles spaniel who was presented to Kansas State University Veterinary Health Center (KSU VHC) for evaluation following vehicular trauma.

• Owner states patient ran out the front door and was struck by a passing car.

• Per owner: patient is current on vaccines, heartworm prevention, flea and tick prevention through rDVM.

Thoesen, Allen & Biller, (2014)Cavalier King Charles Spaniel (2015)

ASSESSMENT• Upon arriving at KSU VHC patient was in cardiovascular shock.

Patient was tachycardic and had a Systolic BP of 90. Patient was given a bolus of 150ml LRS and (kept on 50ml/hr through out the night). Patient was given prednisolone 10mg orally and hydromorphone 0.3mg IV. Laceration was closed via staples. Patient stabilized.

• Patient was hypothermic throughout the night and had frank blood on thermometer at presentation and at the two hour check. Rectal bleeding and hypothermia had resolved by the next morning. Radiographs scheduled to assess abdomen.

Weight: 14.7lbs (6.7kg)BCS: 3.5/5TPR: 97.4F- Rectal, 180bpm, 30bpmCRT: >2secMM: PaleGeneral appearance: Lateral Recumbency Skin/coat: Longitudinal abdominal lacerationEyes/fundic exam: NormalEars/otoscopic exam: NormalOral cavity: NormalMusculoskeletal: Mild hind limb paresisCardiovascular: Tachycardia, low diastolic BPGastrointestinal: Rectal bleedingRespiratory: Lungs clear.Genitourinary: Spayed, Possible ruptured bladderNervous system: No CNS dysfunction

Thoesen, Allen & Biller (2014)

Choi, Kim, & Youn (2009)

SURVEY RADIOGRAPHS• Two survey radiographs were performed

to assess patient. Right lateral and a VD.

R. Lat

VD

Findings• Numerous pelvic

fractures . • Abdomen pendulous

with loss of abdominal detail.

• Inability to visualize bladder.

Differential diagnoses• Hemorrhage• Urine Leakage• Peritonitis

Thoesen, Allen & Biller (2014)

POSITIVE-CONTRAST RETROGRADE CYSTOGRAPHYSuspecting a ruptured bladder the veterinarian orders a positive-contrast retrograde cystography.

What is a positive-contrast retrograde cystography?Cystography is the study of the bladder via the retrograde infusion of a contrast media (in this case a positive media) though a urinary catheter.

Why would you need a retrograde cystography?Clinical indications for a retrograde cystography include abnormal urine, abnormal urination, trauma and abnormalities noted on survey radiographs.

Brown & Brown (2014)

SEDATION AND SUPPLIES

Supplies needed:• Water soluble organic iodide diluted to 150-200mg of iodine/ml,

3-12ml/kg• Foley catheter• Vaginal speculum• Sterile lubricate jelly• Light source• 20-50ml syringes• 2% lidocaine jelly• Three-way valve• 2ml, 2% lidocaine without epinephrine• Source to deposit urine

Patient has already been medicated with hydromorphone (0.3 mg IV) for pain. The veterinarian suggest masking patient down with isoflurane due to kidney values and recent cardiac shock. Patient was masked down with isoflurane at 5% until patient’s palpebral/swallowing reflex were absent. Patient was intubated and maintained on 2% iso.

Thoesen, Allen & Biller (2014)Brown & Brown (2014)

PROCEDURE

• Apply 2% lidocaine jelly on the tip of a premeasured Foley catheter. Aseptically and atraumatically insert until the catheter tip is within the urinary catheter. Suture in place to reduce movement of catheter.

• Gently try and empty the bladder and note urine volume.

• Foley catheter was inflated.

• Patient had 14ml of positive contrast medium infused into bladder. Leakage was not noted. As the veterinarian suspected a ruptured bladder the Foley catheter was deflated and an additional 9ml of positive contrast media was infuse into bladder.

Thoesen, Allen & Biller (2014)

FINDINGS

When the balloon catheter was inflated it was covering the rupture that was suspected in the bladder. This is why the first infusion of contrast media did not detect the problem. When the balloon catheter was deflated and the additional contrast media was infused the veterinarian found the patient to have a ruptured bladder neck or proximal urethra.

First infusion, no rupture noted Second infusion, rupture notedThoesen, Allen & Biller (2014)

SURGICAL INTERVENTION & RECOVERY

Patient was taken to surgery following the diagnosis of a ruptured bladder neck. Foley catheter had been left in place for surgery.

• Patient was surgically prepared following guidelines of an abdominal surgery.

• The bladder rupture was closed with 4/0 monocryl, taper point needle in a simple interrupted pattern.

• 10ml of sterile saline was flushed into the bladder to check for any leakage. No leakage noted.

• Linea alba was closed with 3/0 monocryl, taper point needle in a simple interrupted pattern.

• Subcutaneous layer was closed with 4/0 moncryl, taper point needle in a simple continues pattern.

• Skin was sutured with 4/0 ethilon, reverse cut needle using a cruciate pattern.

Patient recovered from surgery uneventful and was taken to recovery. Foley catheter was left in place as patient is unable to stand due to fractured pelvis. Patient will be referred to orthopedic surgeon.

Novartis (2015)

References Brown, M., & Brown, L. (2014). Small Animal Special Procedures. In Lavin's radiography for veterinary

technicians (Fifth ed.). St. Louis, Missouri: Elsevier.

Cavalier King Charles Spaniel Males of Inez Cavaliers MN. (2015, January 1). Retrieved March 8, 2015, from

http://inezcavaliers.tripod.com/id5.html

Choi, U., Kim, H., & Youn, H. (2009, March 31). A suspected case of Lyme borreliosis in a hunting dog in Korea.

Retrieved March 8, 2015, from http://synapse.koreamed.org/DOIx.php?id=10.4142/jvs.2009.10.1.89&vmode=PUBREADER

Thoesen, M., Allen, P., & Biller, D. (2014, February 1). Positive-contrast cystography in a dog with a hard-to-detect

bladder rupture. Retrieved March 8, 2015, from

http://veterinarymedicine.dvm360.com/positive-contrast-cystography-dog-with-hard-detect-bladder-rupture?rel=canonical

Welcome to the Ethicon Homepage - Novartis Animal Health US, Inc. (2015, January 1). Retrieved March 8, 2015,

from http://www.ethicon.novartis.us/surgeryOverview/cystotomy/