Bilateral Ureterolithiasis and Hydronephrosis in a 10-Year-Old Female Spayed DLH Cat: Our Case Of the Month February 2018
"OUCH!" Acute pain on palpation…. who would have thought there would be not one, but TWO ureteroliths causing pain in this DLH feline patient. Normal ureters are generally NOT visible on a scan, but acute pain in the region of the kidneys should clue you in to pay particular attention to the kidney region, including use of not just the micro convex probe but also the linear probe to highlight and create those “artistic” views. When you find pathology, such as a dilated ureter, FOLLOW it and see where it goes and what may be hiding there…. Our 17-point SDEP Abdomen protocol teaches you how to do this routinely with EVERY patient, and every potential pathology. Many thanks to Dr. Candace Remcho of West Hills Animal Hospital in Corvallis, Oregon for the proficient case management of this patient, as well as the comprehensive interpretation of this case by the newest addition to the Sonopath Team of Specialists, Dr. R.McKenzie “Mac” Daniel, DVM, DABVP (Canine and Feline). Also, a loud shout out to Heidi Putnam, clinical SDEP sonographer of Animal Sounds NW Veterinary Mobile Ultrasound for the exemplary imaging.
The patient presented for pain in the area of the kidneys, dehydration, and anorexia with increased renal values. The patient initially improved after treatment with I.V. fluids, but the symptoms returned 5 days later. Cerenia, SQ fluids, and buprenorphine were added to the treatment plan. Preliminary blood chemistry revealed BUN 128, creat. 7.6 which improved to a BUN of 29 and a creat. of 2.2; all other parameters were WNL.
The left kidney was small in size with mildly irregular margination. Moderate hydronephrosis was present with obliteration of the renal medulla parenchyma. Indistinct corticomedullary differentiation was present between the cortex and remaining medulla. The hydronephrosis in the left kidney measured 1.6 x 0.8 cm and extended into the proximal left ureter. Left ureter dilation measured 0.3 cm. A focal, echogenic ureterolith with acoustic shadowing was present within the lumen of the left ureter and measured 0.3 cm in diameter and was located approximately 0.5 cm from the renal pelvis. The left kidney measured 2.3 cm in length. The right kidney presented normal in size and margination with indistinct corticomedullary distinction and emerging mild hydronephrosis was present. Mild obliteration of the right renal medulla parenchyma was noted. The hydronephrosis in the right kidney measured 0.9 x 0.8 cm and extended into the right ureter. Right ureter dilation measured 0.3 cm. A focal, echogenic ureterolith with distal acoustic shadowing was located approximately 2.0 cm from the right kidney renal pelvis.