8-year-old, Male Neutered, Dogue de Bordeaux

History: The patient presented for difficulty walking and not drinking water.  Occasional dysuria present as well.

Images:

Findings:

The urinary bladder is delineated by a thin rim of irregular gas opacity.

There is no evidence of urolithiasis.

The liver may be reduced in volume, but the patient is rotated, and this could be artifactual.

Serosal and retroperitoneal contrast are poor, likely due to minimal intra-abdominal fat.

Musculoskeletal changes are spondylosis, lumbar articular process osteoarthritis of various degrees, stifle osteoarthritis and mild coxofemoral osteoarthritis.

Conclusions:

Emphysematous cystitis. 

Multifocal skeletal degenerative changes.  Whether these are associated with the patient’s difficulty walking cannot be evaluated from survey radiographs.

Recommendations:

Routine hematology and serum chemistry.

Urinalysis with sediment evaluation and culture and sensitivity testing.

Avoid cystographic procedures due to likely fragility of urinary bladder.

Discussion:

The following comes from a review of emphysematous cystitis in 27 dogs.1

Clinical signs:Hematuria predominates

Gas location: Wall and lumen 14/27; wall only 9/27; lumen only 4/27.

Most frequent bacterial isolates : Eschericia coli, Enterococcus spp., Klebsiella pneumoniae, Proteus mirabilis, Streptoccus spp., Actinomyces spp.

Most common comorbidities:

Diabetes mellitus 9/27; neurologic disease 7/27; adrenal disease 5/27.  Note:  although glucosuria is considered the most important risk factor for emphysematous cystitis, most dogs in this review were not diabetic.

In humans without glucosuria, gas production without glucosuria is thought to be related to fermentation of albumin.2

A general review is also available.3

References:

1.Merkel LK et al.  Clinicopathologic and microbiologic findings associated with emphysematous cystitis in 27 dogs.  J Am Anim Hosp Assoc 53:313, 2017.

2.Grupper M et al.  Emphysematous cystitis:  illustrative case report and review of the literature.  Medicine (Baltimore) 86:47, 2007.

3.Fumeo M et al.  Emphysematous cystitis:  review of current literature, diagnosis and management challenges.  Veterinary Medicine:  Research and Reports 10:77, 2019.

Banner photo courtesy of  David White on Unsplash

2 comments

  1. Findings:
    Laterolateral (LL) and ventrodorsal (VD) view of the abdominal cavity is available. The most cranial part of the abdominal cavity and Th-L junction is missing on the VD view. There is a severe osteoproliferative lesion with sclerosis on the vertebral arch of L3-4. The articular facets of L3-4 are not clearly visible, but no osteolytic lesions are seen. Vertebral bodies of this space are normal. Asymmetric intervertebral space L2-3 is visible on the VD view, widening of the space on the right side. Multiple osteoproliferative lesions on the ventral surface of Th and L vertebral bodies are visible. Mild osteoarthrosis in hip joints is present.
    The abdominal cavity seems unremarkable.
    Conclusion:
    Focal osteoproliferative lesion of the vertebral arch L3-4. DifDg – chronic inflammatory lesion (arthritis of the accessory vertebral joint), degenerative lesion, neoplasia.
    The asymmetry of the L2-3 space could be a result of positioning, but posttraumatic change can not be excluded.
    Multiple spondylosis deformans and mild hip joint arthrosis. Could be accidental findings.

  2. Findings:
    The intervertebral disc space L2-L3 is narrowed when compared to its adjacent disc spaces on the lateral projections. On the VD projection narrowing of the left side of the intervertebral disc space L2-L3 is also evident. There is ill defined mineral opacity superimposed with the left articular facet joint at L1-L2. A sharply marginated triangular mineral opacity is superimposed with the right craniolateral aspect of L2. The left articular process of L2-L3 is inconspicuous. Multiple articular facet joints of the lumbar spine are sclerotic. These changes are seen best on the lateral projection. Degenerative changes with variable degrees of severity are also seen associated with the articular facet joints of the remaining lumbar vertebrae with L3-L4 having the more severe proliferative changes. Ventral spondylosis is seen associated with multiple lumbar vertebrae. A thin radiolucent rim is seen surrounding the urinary bladder. Within the limitation of one lateral projection, there is subjective cranial displacement of the gastric axis. No other significant abnormalities are seen within the included portions of the abdomen.

    Conclusion:
    Sharply marginated triangular mineral opacity superimposed with the right craniolateral aspect of L2 may represent a fractured or dysplastic articular process. Articular process hypoplasia/aplasia cannot be completely excluded. Correlate with medical and clinical history to rule in/out any possible trauma.
    The ill defined mineral opacity superimposed with the left aspect of the intervertebral disc space L1-L2 likely represents chronic degenerative changes. A malignant proliferative lesion is considered much less likely.
    Narrowing of the left aspect of the intervertebral disc space L2-L3 is most likely causing a compressive myelopathy leading to the reported clinical signs. Advanced imaging such as MRI or CT could be used for further evaluation of the spinal cord, intervertebral discs, and articular processes of the lumbar spine.
    Osteoarthrosis of multiple articular facet joints within the lumbar spine. Chronic joint instability might be contributing to these changes.
    Radiolucent rim surrounding the urinary bladder most consistent with emphysematous cystitis. Emphysematous cystitis has been reported to be associated with gas producing bacteria bacteria as a result of fermentation of either glucose or albumin. A urine culture and urinalysis is recommended. A cystocentesis should not be considered as a medium for obtaining the urine sample in this case given the concurrent intramural changes.
    Cranial displacement of gastric axis may be due to patient’s deep chest conformation of may represent microhepatica. Differentials for microhepatica include: chronic liver disease or portosystemic/microvascular shunting. Obtaining a full abdominal radiographic study (3 view) or performing an abdominal ultrasound could be considered to further evaluate the liver.

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