1887

Radiology of the abdomen

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Abstract

Abdominal radiography is indicated for a wide variety of conditions, not only primary abdominal disease but also other disorders which may involve, or entend into, the abdomen. Radiography and ultrasonography are complementary imaging techniques and, if the equipment and funds are available, performing both will provide more information than a single modality alone. There are challenges associated with abdominal radiology of the dog and the cat. For example, superimposition of the abdominal organs and viscera – the abdomen has greater superimposition of structures than most other body areas with the exception of the skull. Additionally, there is relatively poor tissue contrast. The interpretation of abdominal radiographs is hindered by the similar opacity of the majority of tissues within the abdomen; the inherently poor contrast is compounded by the greater amount of scatter created in the areas of the abdomen compared with other body areas. This chapter discusses the specific approach to the liver; pancreas; adrenal glands; urinary tract; male reproductive tract; and female reproductive tract.

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Figures

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6.1 Patient positioning for a right lateral view of the abdomen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.2 Patient positioning for a right lateral view of the abdomen with the hindlimbs pulled cranially to facilitate evaluation of the urethra in a male dog. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.3 Patient positioning for a VD view of the abdomen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.4 Patient positioning for a horizontal beam decubitus view of the abdomen with the animal in left lateral recumbency. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.5 Right and left lateral views of the normal canine abdomen. 1 = gastric fundus and body of the stomach; 2 = pylorus (fluid-filled on right lateral view; gas-filled on left lateral view); 3 = liver; 4 = spleen (tail); 5 = left kidney (caudal pole); 6 = descending colon; 7 = small intestine; 8 = descending duodenum; 9 = caudal vena cava. (Courtesy of the University of Bristol)
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6.6 VD view of the normal canine abdomen (same patient as in Figure 6.5 ). 1 = body of the stomach; 2 = pylorus; 3 = liver; 4 = descending duodenum; 5 = caecum; 6 = transverse colon; 7 = descending colon; 8 = spleen (head). (Courtesy of the University of Bristol)
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6.7 Right lateral view of the normal feline abdomen. The large lumbar muscles in the cat are recognized as sharply defined soft tissue bands (arrowed) ventral to the vertebral column. 1 = liver; 2 = gastric fundus and body of the stomach; 3 = pylorus; 4 = right kidney; 5 = left kidney; 6 = small intestine; 7 = transverse colon; 8 = descending colon; 9 = bladder. VD view of the normal feline abdomen. The large lumbar muscles in the cat are recognized as sharply defined soft tissue bands (arrowed) on both sides of the vertebral column. 1 = liver; 2 = gastric fundus and body of the stomach; 3 = pylorus; 4 = right kidney; 5 = left kidney; 6 = small intestine; 7 = transverse colon; 8 = descending colon; 9 = bladder; 10 = spleen (head).
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6.8 The pancreas and its associated anatomical landmarks. The pancreas is V-shaped: the body (B) lies to the left of the pyloroduodenal angle with the left (LL) and right (RL) lobes extending caudal to the body of the stomach (St) and medial to the descending duodenum (Duo), respectively. The accessory pancreatic duct (APd) is the primary excretory duct in dogs and terminates at the minor duodenal papilla. The pancreatic duct (Pd) is the main excretory duct in cats and terminates at the major duodenal papilla together with the common bile duct (Bd). Gb = gallbladder; LK = left kidney; RK = right kidney; S = spleen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.9 Renal size is estimated by comparing renal length with the length of L2 on the VD view. In the cat, normal renal length is 1.9–2.6 times the length of L2. In this case, the left kidney (LK) is 2.4 times the length of L2.
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6.10 Röntgen sign: size. Physiological distension of several organs, such as the stomach, bladder and uterus (due to pregnancy), can be substantial and should not be mistaken for disease. Pain may lead to delayed gastric emptying or reluctance to defecate or void urine. Physiological distension results in the displacement of other abdominal structures, especially small intestinal loops, as in this example of a dog with bladder distension (arrowed) due to urethral obstruction.
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6.11 Röntgen sign: size. Lateral view of the abdomen of a cat with a hiatal hernia. The cranioventral abdomen (white arrow) appears ‘empty’ due to displacement of the stomach through the hernia (black arrows). In addition, the abdominal volume is small due to little, if any, abdominal and retroperitoneal fat (*), resulting in a ‘tucked up’ appearance and poor abdominal contrast.
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6.12 Röntgen sign: size. Lateral view of the abdomen of a small-breed dog with ascites, resulting in abdominal distension. The ventral wall is pendulous (arrowed), the serosal margins, including that of the bladder, are blurred and the gas-filled intestinal loops have gathered or ‘floated’ centrally. Lateral view of the abdomen of an emaciated dog with chronic diarrhoea and an intussusception (I). There is reduced muscle bulk (solid white arrow) dorsal to the spinous processes of the lumbar vertebrae, indicating emaciation. The abdomen has a ‘tucked up’ appearance (dashed white arrow) due to a combination of abdominal discomfort and emaciation.
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6.13 Röntgen sign: shape. Right lateral view of the abdomen of a dog with haematuria due to renal carcinoma. The mid-dorsal margin of the right kidney (arrowed) has been expanded by a trapezoidal mass. Magnified view.
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6.14 Röntgen sign: number. Lateral view of the thorax and abdomen of a Persian cat with dyspnoea. Ultrasonography was initially performed, but as a diaphragmatic defect and displacement of viscera was recognized during the study, radiography was requested. The radiographic study revealed a large diaphragmatic hernia. The small intestinal loops have herniated into the thorax and the stomach is abnormally positioned with the pylorus (P) located craniodorsally and the body (B) located caudoventrally. The ascending colon (C) has also been displaced into the thorax. The location of the liver and spleen is uncertain, but herniation of all or part of these structures into the thorax is possible. This case emphasizes the value of radiography, as it provides a more comprehensive assessment of the displaced viscera than ultrasonography. (Courtesy of MyVet 24/7)
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6.15 Röntgen sign: opacity. Lateral view of the abdomen of a dog with a large intra-abdominal lipoma. The lipoma displaces the small intestinal loops cranially (arrowed) and the bladder (B) caudally. However, as the mass is of fat opacity, it is more lucent than the adjacent soft tissue structures and their serosal margins remain visible. The mass is so large that it has resulted in a marked generalized enlargement of the abdomen.
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6.16 Röntgen sign: margination. Lateral view of the abdomen of a dog with localized peritonitis due to pancreatitis. There is a generalized increase in soft tissue opacity in the mid-cranial abdomen caudal to the stomach (black arrows). The serosal surfaces of the small intestine and cranial colon and the caudal margin of the stomach and liver are blurred. As the peritonitis and abdominal fluid are localized, the margins of other, unaffected, areas of the abdomen (e.g. the ventral margin of the liver and the ventrally located small intestinal loops) remain better defined (white arrows).
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6.17 Röntgen sign: position. Lateral view of the abdomen of a dog with a craniodorsal mass. The large soft tissue mass (arrowed) has displaced the small intestine ventrally and caudally. VD view of the abdomen of a dog with a craniodorsal mass. As the mass (arrowed) arises in the left craniodorsal abdomen, the descending colon (C) has been displaced towards the right and the left kidney (LK) has been displaced slightly caudally. Masses in this location may arise within the left retroperitoneal space or from the left limb of the pancreas or stomach. The head of the spleen (Sp) is visible in this dog.
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6.18 Röntgen sign: position. Lateral view of the abdomen of a dog with a cranioventral mass. A large soft tissue mass (arrowed) arising from the cranioventral abdomen (liver) has displaced the body of the stomach (S) caudally and dorsally. The transverse colon (C) is also displaced caudally, and the small intestines caudally and ventrally. Masses in this location may arise from the liver, spleen or stomach.
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6.19 Röntgen sign: position. Lateral and VD views of the abdomen of a dog with a mid-abdominal mass. A large soft tissue mass (arrowed) lies within the centre of the abdomen and has displaced the small intestinal loops peripherally. On the VD view, the mass lies on the midline. There is no displacement of the descending colon, stomach, bladder or kidneys. Masses in this location may arise from the mesenteric lymph nodes, small intestine or, occasionally, the ovaries or a retained testicle.
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6.20 Röntgen sign: position. Lateral view of the abdomen of a dog with a mid-ventral mass. The large soft tissue mass (arrowed) has displaced the small intestines dorsally and cranially. The mass lies along the ventral abdominal wall. Caudal displacement of the small intestines is limited to some extent by moderate filling of the bladder. Masses in this location usually arise from the tail of the spleen or, occasionally, a peripheral small intestinal loop. L = liver; S = spleen.
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6.21 Röntgen sign: position. Lateral view of the abdomen of a dog with a caudodorsal mass. The large soft tissue mass (arrowed) has displaced the descending colon and bladder ventrally. Masses in this location arise from the caudodorsal retroperitoneal space and may be associated with lymphadenopathy as a result of lymphoma or other neoplasms arising within the pelvis, anal sac adenocarcinoma or prostatic carcinoma.
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6.22 Röntgen sign: position. Lateral view of the abdomen of a cat with a caudal mass. The large soft tissue mass (arrowed) has displaced the small intestinal loops cranially and the descending colon dorsally. The bladder cannot be identified. The margin of the mass is sharply defined cranioventrally. Masses in this location can arise from the bladder, uterus, prostate gland or bladder wall. The size of the mass suggests that is not likely to be associated with physiological or pathological distension of the bladder. A cystic mass is an important consideration. (Courtesy of MyVet24/7)
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6.23 Röntgen sign: position. Lateral and VD views of a dog with a large mass (lipoma) arising in the mid-dorsal abdomen. The large mass (*) is of fat opacity and displaces the descending colon (C) and small intestines (solid arrows) ventrally on the lateral view and towards the midline on the VD view. The left kidney (LK) is displaced slightly cranially and ventrally by the mass. Masses in this location can arise from the retroperitoneal space or, occasionally, from the mesenteric root. Note the several small irregular rounded mineralized bodies (dashed arrows) within the subcutis, consistent with calcinosis cutis. Ca = caecum; RK = right kidney.
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6.24 Left lateral view of the abdomen of a skeletally mature dog with a pyloric outflow obstruction. The stomach (arrowheads) is markedly distended and rounded and the small intestines are caudodorsally displaced. The generally homogeneous soft tissue opacity of the stomach suggests predominantly fluid content. Note the accumulation of particulate mineralized material (white arrows) within the ingesta in the pylorus consistent with a ‘gravel sign’, indicating chronic obstruction. A small volume of air in the non-dependent region of the stomach highlights thick sinuous rugal folds (black arrow).
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6.25 Lateral view of a dog with a cranial mediastinal mass and hypercalcaemia. Mineralization of the rugal folds is recognized as several linear opacities in the body of the stomach (arrowed). Lateral view of a dog with chronic renal failure. The wall of the pylorus (arrowed) is mineralized.
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6.26 Right lateral and VD views of the abdomen of a dog with a gastric foreign body (a child’s dummy). Although the stomach is empty the foreign body may still be responsible for causing obstruction as the dog may recently have vomited. The foreign body is easily recognized (especially on the lateral view) due to gas surrounding both the external and internal surfaces (arrowheads).
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6.27 Right lateral view of the abdomen of a dog with GDV. The pylorus (white arrowheads) is rotated dorsally and is markedly dilated (mainly with air). The body and fundus of the stomach (black arrowheads) are also dilated and rotated ventrally and contain a mixture of gas and fluid. Rotation of the stomach has resulted in a soft tissue opacity (*) partially dividing the dilated gastric lumen cranially. Although occasionally referred to as ‘compartmentalization’, this in truth just represents a fold in the gastric wall. Loops of gas-filled small intestine are caudally displaced. The spleen cannot be clearly identified. (Courtesy of the University of Bristol)
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6.28 Right lateral survey radiograph and lateral and VD positive-contrast gastrograms of a dog with a gastric tumour. (a) Gastric wall thickening or a gastric soft tissue mass (arrowed) is suspected, but the extent of the changes cannot be distinguished from the luminal fluid. (b–c) The extent of the marked irregular thickening of the wall of the body due to the gastric mass can be recognized (double-headed arrows). The mass appears as a large soft tissue filling defect on both the cranial and caudal margins of the stomach. There is no filling or distension of the lumen of the body of the stomach. The changes extend into the pylorus and proximal duodenum, where smaller filling defects (arrowheads) are visible. Note the focal narrowing of the segment of small intestine in the caudal abdomen in (b) due to a peristaltic wave (dashed white arrow) as well as the Peyer’s patches (solid white arrows) on the anti-mesenteric border of the descending duodenum (D). F = fundus. (Courtesy of the University of Bristol)
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6.29 Functional ileus of the small intestine in a dog and a cat. Distended gas-filled loops occupy the entire abdomen. It is important to distinguish the large intestine (black double-headed arrows) from the small intestine (white double-headed arrows) based on the appearance of the intestinal contents and location. Large intestinal content is usually granular. The transverse colon can form a prominent loop in the craniodorsal abdomen caudal to the stomach. (b, Courtesy of the University of Bristol)
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6.30 Right lateral view of the abdomen of a dog with chronic partial obstruction of the small intestine. A loop of small intestine in the mid-ventral abdomen is dilated by a large accumulation of mineralized material (double-headed arrow). The appearance is typical of a ‘gravel sign’. It can be distinguished from mineral in normal faeces based on the ventral location of the loop within the abdomen and recognizing the appearance and location of the normal colon (*). C = caecum. (Courtesy of the University of Bristol)
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6.31 Right lateral, left lateral and VD views of the abdomen of a dog with a small intestinal obstruction secondary to a foreign body (corn cob). Although the small intestine is not markedly dilated (double-headed arrow), the duodenum and proximal jejunum remain gas-filled on all three views, suggesting a proximal small intestinal obstruction. The foreign body (arrowheads) has a consistent appearance on all views – it is roughly rectangular with parallel geometric rows of small gas bubbles. Note that the gas within the gastric lumen changes location as the position of the dog changes. Magnified view of the corn cob foreign body. CDF = caudal duodenal flexure; J = jejunum; P = pylorus; PD = proximal duodenum.
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6.32 Lateral and VD views of the abdomen of a dog with a small intestinal obstruction secondary to a linear foreign body. The small intestine is gathered in the mid-ventral abdomen and to the right of the midline (arrowheads). Plication of the small intestine results in variably sized, crescentic to rounded, gas opacities. B = bladder.
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6.33 Lateral and VD views of the abdomen of an immature bitch with an ileocolic junction intussusception. The intussusceptum (invaginating loop) appears as a homogeneous tubular soft tissue opacity (I), highlighted by gas within the surrounding intussuscipiens (arrowheads = receiving loop). The poor serosal detail is typical of a young animal and does not necessarily indicate the presence of free abdominal fluid.
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6.34 Right and left lateral views of the abdomen of a dog with an intestinal mass. The irregularly shaped soft tissue mass lies in the caudoventral abdomen, just cranial to the bladder (arrowed). The small intestinal loops are of normal diameter (not obstructed). The mass is surrounded by small intestinal loops, indicating that it probably lies within the mesentery. Note that abnormal structures (masses, lymph nodes, cysts) can only be recognized when they exceed the diameter of the adjacent small intestinal loops by two to three times. The mass is not visible on the right lateral view.
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6.35 Right and left lateral views of the abdomen of a dog with intestinal perforation secondary to duodenal ulceration. Serosal detail is poor due to a relatively large volume of free abdominal fluid. (a) A large pocket of gas (black arrows) is evident in the craniodorsal abdomen caudal to the stomach (S). Smaller gas bubbles (white arrow) are more difficult to distinguish from gas within the intestinal loops. (b) The large gas pocket (arrowed) is located more cranially and highlights the caudal aspect of the left crus of the diaphragm. The duodenum (D) contains gas and has a corrugated appearance (due to spasm of the intestinal smooth muscle) (see also Figure 6.97 ).
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6.36 Lateral and VD views of the abdomen of a cat with constipation, secondary to a fracture, which has resulted in narrowing of the pelvis. The diameter of the colon is markedly increased. The lumen is filled with dense, partially mineralized faecal material. Almost the entire length of the colon is affected (arrowheads). The distension of the colon stops abruptly at the pelvis. The rectum does not contain any faecal material. A comminuted left ilium fracture (non-union) with medial displacement of the caudal fragment is the cause of the narrowing of the pelvis (arrowed).
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6.37 Lateral survey radiograph and lateral and VD retrograde urethrograms of an intact male dog with dysuria due to a perineal hernia. (a) A large swelling (arrowed) extends dorsally from the caudal pelvis, elevating the tail. The swelling is of soft tissue opacity and there is a large faecal ball containing finely mineralized material superimposed on the centre of the swelling. The caudal abdomen has an empty appearance. The bladder is not recognized and the small intestinal loops (*) extend further caudally than normal to the pubis. (b–c) Retrograde urethrography has been performed. The bladder (B) has retroflexed (white arrows) into the perineal hernia and is partially filled with contrast medium on the lateral view. On the VD view, the large volume of faeces (F) within the right side of the hernia has displaced the bladder to the left. The urethra is denoted by the black arrows.
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6.38 Lateral view of the abdomen of an elderly cat with carcinoma of the distal descending colon. The descending colon is distended with dense faecal material but tapers abruptly at the level of L7. The annular soft tissue mass (arrowheads) surrounds the narrow and irregular lumen of the colon (*). Ultrasonography or barium contrast studies would provide further information about the lesion. The lack of serosal detail in this case is due to the poor body condition of the cat and the lack of mesenteric or retroperitoneal fat. As a result, the outer margins of the mass cannot be recognized. (Courtesy of the University of Bristol)
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6.39 Lateral view of the abdomen of a dog with a colocolic intussusception. The intussusceptum appears as a soft tissue mass within the caudal descending colon. The cranial and caudal borders of the intussusceptum are bordered by gas (arrowed), creating the impression of a convex ‘meniscus’. The colon (C) orad to the intussusception is filled with faecal material. Note that a catheter has been placed within the rectum to inflate the colon with air, providing better contrast (pneumocolon).
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6.40 Lateral view of the abdomen of a bitch with generalized hepatomegaly due to diabetes mellitus. The caudoventral margin of the liver extends well beyond the margins of the costal arch (arrowed), and the pylorus is displaced caudally and lies partially outside the costal margin. Note that the pendulous appearance of the abdomen (probably due to the accumulation of fat within the abdomen, stretching the hepatic ligaments and weakening the ventral abdominal wall muscles) allows the enlarged liver to extend more ventrally.
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6.41 Lateral view of the abdomen of a bitch with localized hepatomegaly due to a focal hepatic mass (arrowheads). The localized area of hepatic enlargement in the mid-cranial abdomen has distorted the body of the stomach (S) and displaced it caudodorsally. Note that the pylorus is curved around the caudoventral aspect of the focal liver enlargement.
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6.42 Lateral view of the abdomen of an adult chondrodystrophic bitch with microhepatica. The liver (double-headed arrow) is a narrow, homogeneous, soft tissue band immediately caudal to the diaphragm. The stomach (S) is difficult to recognize and the gastric axis is rotated cranially. The colon (C) is filled with a large volume of semi-formed faecal material. (Courtesy of the University of Bristol)
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6.43 Lateral view of the abdomen of a cat with jaundice due to cholangiohepatitis. The large granular mineralized body (white arrowhead) superimposed over the ventral liver is consistent with a cholelith in the gallbladder. The collection of smaller choleliths (black arrowhead) cranial to the stomach are located within the terminal common bile duct.
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6.44 Lateral view of the abdomen of an adult bitch with fine mineralization of the gallbladder wall. The fine, curvilinear mineralization (arrowed) involves the ventral wall and is associated with irregularly mineralized choleliths within the gallbladder lumen.
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6.45 Left lateral view of the thorax of a dog with signs of acute abdominal pain. A curvilinear gas opacity (arrowed) is superimposed over the ventral liver in the region of the ventral aspect of the gallbladder. The changes are consistent with gas within the wall of the gallbladder (emphysematous cholecystitis) associated with a gallbladder mucocele (a form of necrotizing cholecystitis).
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6.46 Lateral view of the abdomen of a dog with a hepatic mass. The large, rounded, soft tissue opacity mass (white arrows) in the cranial mid- and ventral abdomen has caused marked caudal and dorsal displacement of the stomach (S). The kidneys and intestines are also caudally displaced. There is stippled mineralization within the cranioventral liver (black arrows). The spleen is not visible on this view. (Courtesy of the University of Bristol)
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6.47 Lateral view of the abdomen of a cat with an extrahepatic shunt following mesenteric portovenography. A large anomalous vessel (black arrowheads) filled with contrast medium loops caudally to join the caudal vena cava ventral to L5 (white arrowheads). There is slight retrograde filling of the proximal portal vein (arrowed), which is reduced in diameter compared with the shunting vessel. (Courtesy of the University of Bristol)
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6.48 Lateral and VD views of the abdomen of a dog with hyperadrenocorticism. There is marked generalized hepatomegaly. The rounded caudoventral hepatic margin (arrowheads) extends well beyond the costal arch. Abdominal distension secondary to hepatomegaly and muscle weakness results in a ‘pot-bellied’ appearance to the abdomen. Radiopaque calculi are present within the urinary bladder (arrowed). (Courtesy of the University of Bristol)
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6.49 Lateral view of the abdomen of a cat with a large volume of abdominal fluid. The abdomen has a pendulous appearance. The serosal surfaces of the abdominal organs and viscera are almost completely effaced by the fluid. However, assessment of the angle of the gastric axis (white line) allows hepatic size to be estimated. (Courtesy of the University of Cambridge)
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6.50 Lateral view of the abdomen of a male dog with marked generalized splenomegaly. The enlarged spleen (double-headed arrows) curves caudally and then folds and extends cranially, with the tip of the spleen located caudal to the costal arch. (Courtesy of the University of Bristol)
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6.51 Lateral view of an adult cat with splenomegaly (double-headed arrows). In the normal cat, the spleen is usually not visible on a right lateral view.
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6.52 Lateral view of the abdomen of a dog with a splenic abscess. The abscess appears as a poorly marginated, soft tissue mass (arrowheads) in the mid-ventral abdomen, within which is an area of mottled gas opacity. (Courtesy of the University of Bristol)
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6.53 Lateral view of the abdomen of a dog with a mass arising from the body of the spleen. The rounded soft tissue mass (arrowheads) in the mid-ventral abdomen has displaced the small intestines caudally. VD view of the abdomen of a dog with a mass arising from the body of the spleen. The mass (arrowed) has displaced the large intestine caudally and towards the midline.
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6.54 Lateral view of the abdomen of a cat with a mass arising from the head of the spleen (arrowheads). The stomach has been displaced cranially and the kidneys have been displaced caudoventrally (arrowed). (Courtesy of N Hayward)
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6.55 Lateral view of the abdomen of a dog with pancreatitis. The localized loss of serosal detail in the mid- and craniodorsal abdomen is secondary to pancreatic inflammation and localized peritonitis (arrowed). The transverse colon (C) no longer lies adjacent to the caudal aspect of the stomach.
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6.56 Lateral view of a cat with pancreatitis. The transverse colon (*) is displaced caudally away from the stomach (S) by a soft tissue opacity with poorly circumscribed, hazy margins (arrowed) consistent with an enlarged left limb of the pancreas. (Courtesy of N Hayward)
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6.57 Lateral and VD views of the abdomen of a cat with a pancreatic mass. The mass (arrowheads) in the mid-ventral abdomen is large and irregularly rounded and displaces the colon (*) caudally and dorsally. LK = left kidney; RK = right kidney; S = stomach; Sp = spleen. (Courtesy of N Hayward)
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6.58 Lateral view of the abdomen of a cat with mineralized adrenal glands (arrowed). Incidental mineralization in older cats should be distinguished from other causes of abdominal mineralization which may be of clinical significance (e.g. ureteric calculi). (Courtesy of N Hayward)
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6.59 Lateral and VD views of the abdomen of a dog with a mineralized right adrenal gland mass. The mass (arrowheads) in the right craniodorsal abdomen is densely mineralized. The right kidney is not well visualized on either view. The caecum is denoted by the asterisk. (Courtesy of G Hammond, University of Glasgow)
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6.60 Lateral and VD intravenous urograms in a normal neutered male dog. The ureters (arrowed) terminate normally at the trigone of the bladder. These images were taken approximately 5 minutes after the intravenous administration of contrast medium. The renal parenchyma (right kidney = black arrowheads; left kidney = white arrowheads), renal pelves and ureters are opacified and contrast medium is seen entering the bladder. A pneumocystogram has been performed to facilitate identification of the ureteric terminations. (Courtesy of the University of Bristol)
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6.61 Lateral and VD views of the abdomen of a cat with unilateral renomegaly. The enlarged right kidney (arrowheads) is superimposed on the smaller left kidney (double-headed arrow) on the lateral view. On the VD view, the left kidney is difficult to define due to the bulk of the sublumbar muscles (arrowed). The differential diagnoses for unilateral renomegaly with smooth margins and a homogeneous appearance include severe hydronephrosis (obstructive), compensatory hypertrophy, perirenal pseudocyst or unilateral neoplasia. (Courtesy of the University of Bristol)
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6.62 Lateral and VD views of the abdomen of a cat with bilateral perirenal pseudocysts. Both kidneys are markedly enlarged (arrowed). On the lateral view, the kidneys are so large that they silhouette with each other and with the liver cranially and the bladder (B) caudally. On the VD view, the left kidney (LK) appears more markedly enlarged than the right kidney (RK). Note that the small intestines (Sit) are displaced centrally and to the right by the left kidney, and caudally by the right kidney. C = colon.
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6.63 VD view of the abdomen of a cat with bilaterally small and irregular kidneys (arrowed). LK = left kidney; RK = right kidney. (Courtesy of the University of Bristol)
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6.64 Lateral and VD views of the abdomen of a dog with a large ‘staghorn’ calculus within the right renal pelvis (black arrowheads). An additional finding associated with the chronic azotaemia is faint mineralization of the gastric mucosa (white arrowheads). This patient has very prominent nipples (arrowed) which shouldn’t be mistaken for additional areas of mineralization.
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6.65 Lateral and VD views of the abdomen of a cat with ureteric calculi. Although two small mineralized calculi (arrowed) are visible dorsal to the colon on the lateral view, only one, within the left ureter (arrowhead), can be seen on the VD view. The second is obscured by the lumbar vertebrae. The tip of a urinary catheter lies within the bladder and a small gas bubble is superimposed. (Courtesy of the University of Bristol)
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6.66 VD view of the abdomen of a puppy with chronic pyelonephritis secondary to chronic cystitis associated with a bladder diverticulum and calculi. There is reduced serosal detail associated with the age of the dog and the large volume of faecal material. However, it is possible to recognize that the renal margins (arrowed) are irregular, consistent with chronic disease. The renal pelves and ureters are irregularly dilated with indistinct filling defects due to debris (pyonephrosis).
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6.67 Intravenous urography. Lateral (taken after 15 minutes) and VD (taken after 5 minutes) views of the abdomen of a dog following intravenous administration of contrast medium. Both renal pelves and ureters (white arrows) are moderately dilated, consistent with hydronephrosis and hydroureter, respectively. The caudal location of the bladder neck (black arrow) obscures the ureteric terminations; however, the presence of contrast medium in the bladder suggests that at least one ureter terminates in the normal location. There is no spillage of contrast medium around the perineum, which would be expected with an ectopic ureter. To rule out an ectopic ureter, intravenous urography should be followed by a retrograde study. (Courtesy of the University of Bristol)
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6.68 Lateral and VD views of the abdomen of an entire bitch with an ectopic ureter. Retrograde vaginourethrography has been performed. The right ureter is ectopic. It is moderately dilated and terminates abnormally within the proximal urethra (arrowheads). Note that a pneumocystogram has been performed to improve visualization of the termination of the ureters and that there is good distension of the vestibule (Ve), vagina (V) and urethra (U). C = cervix.
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6.69 Lateral view of the abdomen of a bitch with unilateral renal carcinoma. The normal sized left kidney (double-headed arrow) is superimposed on the ventral aspect of the markedly enlarged and irregularly shaped right kidney (arrowheads) in the craniodorsal abdomen. (Courtesy of P Mahoney)
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6.70 Intravenous urography in a dog with a cyst in the right kidney. VD view of the abdomen obtained 5 minutes following the intravenous administration of an iodinated contrast medium. The renal cyst appears as a smoothly marginated, ovoid filling defect in the lateral cortex of the right kidney (arrowheads). The cyst distorts the renal pelvis focally, resulting in a small filling defect. The renal cyst was demonstrated on ultrasonography. Although other differential diagnoses for a focal filling defect include neoplasia, granuloma and abscess, the smooth margins are more suggestive of a benign lesion. Magnified view. (Courtesy of the University of Bristol)
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6.71 Lateral view of the abdomen of a male dog with marked bladder distension secondary to a urethral tumour. The distended bladder (solid arrows) displaces the small intestinal loops cranially and the ventral abdominal wall ventrally. The proximal urethra (dashed arrow) is subjectively increased in diameter. Pathological bladder distension must be distinguished from physiological distension secondary to polydipsia, reluctance to void during hospitalization or pain. The pelvic urethra in bitches, and the pelvic and penile urethra in male dogs, should be evaluated for a cause of the obstruction (particularly calculi).
Image of 6.72
6.72 Lateral view of the abdomen of a dog with chronic cystitis. The bladder is small with fine, irregular, diffuse dystrophic mineralization of the mucosa (arrowed). Note that although the bladder wall appears thickened, it is not possible to assess the thickness without the bladder being adequately distended.
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6.73 Lateral radiographs of the caudal abdomen of two dogs with emphysematous cystitis. The gas (arrowed) within the bladder wall is more difficult to recognize as it is predominantly projected . Some of the gas is projected in profile along the ventral bladder wall and the intramural location (arrowed) is more easily recognized. Further large gas shadows are superimposed on the bladder. Intramural gas must be distinguished from overlying gas-filled small intestinal loops, subcutaneous emphysema and free abdominal gas.
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6.74 Lateral positive-contrast cystogram of a male dog with retroflexion of the bladder into a perineal hernia. Small intestinal loops extend caudally to the pubis as a result of the absence of the bladder. (Courtesy of the University of Bristol)
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6.75 Double-contrast cystogram in a bitch with chronic cystitis. The vertex of the bladder is thickened (double-headed arrow). Polypoid thickening of the mucosa surrounded by gas is recognized in profile (white arrows) as well as (black arrow). Calculi within the central pool of contrast medium appear as stellate filling defects (*). (Courtesy of the University of Cambridge)
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6.76 Lateral views of the cranial abdomen and the pelvis of a male dog with a radiopaque cystic (black arrow) and urethral (white arrow) calculi. The large size of the dog necessitates at least two views for a complete assessment: a view of the cranial abdomen to include the kidneys and bladder; and a view of the caudal abdomen to include the pelvis and urethra. The hindlegs have been pulled forward to avoid superimposition of the fabellae on the os penis, which may be mistaken for calculi. (Courtesy of the University of Bristol)
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6.77 Lateral view of an intravenous urogram and pneumocystogram in a young bitch. Multiple radiolucent filling defects (white arrow) are highlighted by the pool of contrast medium within the bladder. The peripheral, rather than central, location and very rounded appearance of the filling defects are consistent with air bubbles rather than radiopaque calculi. The bladder neck in this animal is caudally located and one of the ureters (ectopic) is mildly dilated (black arrow). (Courtesy of the University of Bristol)
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6.78 Lateral pneumocystogram and lateral intravenous urogram and retrograde urethrogram of a male dog with haematuria due to a bladder tumour. (a) A large, lobulated, soft tissue mass opacity (arrowed) results in a filling defect in the trigone and proximal urethra. (b–c) The terminations of both ureters (arrowed) are surrounded by the mass but not obstructed. Lateral oblique intravenous urogram and retrograde urethrogram of a male dog with haematuria due to a bladder tumour. (b–c) The terminations of both ureters (arrowed) are surrounded by the mass but not obstructed.
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6.79 Lateral double-contrast cystogram and retrograde vaginourethrogram in a bitch with urethral neoplasia. The intrapelvic urethra (arrowed) is of variable diameter, irregularly marginated and poorly filled with contrast medium. Magnified view.
Image of 6.80
6.80 Lateral survey radiograph of the abdomen and positive-contrast retrograde cystogram of a male dog with rupture of the urinary bladder. (a) The margins of the bladder cannot be identified (arrowheads). The abdomen has a pendulous appearance and generalized blurring of serosal detail throughout due to free abdominal fluid. (b) Contrast medium (arrowed) appears as a streak, demonstrating leakage into the abdominal cavity.
Image of 6.81
6.81 Lateral views of the abdomen of two young dogs with bladder (urachal) diverticula. Excretory urography and retrograde vaginourethrography have been performed (same dog as in Figure 6.66 ). The bladder is moderately distended with contrast medium. The ventral bladder wall is thickened and irregular, consistent with chronic cystitis. Contrast medium has also filled the diverticulum at the bladder vertex (arrowed). Magnified view. Excretory urography and pneumocystography have been performed. The renal pelves are dilated and the ureters are dilated and tortuous (one ureter contains air (dashed arrow) and the other contains contrast medium). The bladder is small and the neck is intrapelvic. A large, irregularly marginated, elliptical diverticulum (solid arrow) at the vertex of the bladder is filled with gas.
Image of 6.82
6.82 Normal prostate gland in a young, entire male dog. The cranial aspect (arrowheads) is defined by the small amount of fat between the prostate gland and the bladder neck, body wall and descending colon. (Courtesy of the University of Bristol)
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6.83 Lateral retrograde urethrogram of an entire male dog with benign prostatic hyperplasia. The enlarged prostate gland (arrowheads) is smoothly marginated and symmetrical about the urethra. The margins of the urethra are smooth. There is retrograde filling of the prostatic ducts (arrowed), which is smooth and well defined.
Image of 6.84
6.84 Lateral retrograde urethrogram of a neutered male dog with prostatic neoplasia. Although the prostate gland is not dramatically enlarged, it is larger than would be expected for a neutered dog. The prostatic urethra (arrowheads) is markedly irregular with reflux around the urethra into the prostate gland. There is no evidence of sublumbar lymphadenopathy or reactive new bone formation along the ventral aspect of the lumbar vertebral bodies in this case.
Image of 6.85
6.85 Lateral views of the abdomen of two entire male dogs with paraprostatic cysts. The cyst is large with fine ‘eggshell’ peripheral mineralization (white arrows). A narrow stalk (black arrow) connects the cyst to the prostate gland (P). The bladder is empty. The cyst is small with peripheral mineralization (white arrow) but the stalk (black arrow) connecting the cyst to the prostate gland (P) is long. (a, Courtesy of P Mahoney; b, Courtesy of Vetcall Veterinary Surgery)
Image of 6.86
6.86 Lateral view of the abdomen of a male dog with a neoplastic retained testicle. The retained testicle appears as a mid-abdominal mass (arrowheads) with peripheral displacement of the small intestine.
Image of 6.87
6.87 Lateral view of the abdomen of an entire bitch with uterine enlargement. The uterine horns (arrowheads) can be recognized due to the large volume of intra-abdominal fat and by their orientation and location, extending obliquely cranioventral over the bladder. The uterus can only be distinguished from small intestinal loops when it is 2–3 times the diameter of the small intestinal loops. (Courtesy of the University of Bristol)
Image of 6.88
6.88 Retrograde vaginourethrogram of a bitch. The normal uterine body and horns (white arrowheads) have filled with contrast medium. An ectopic ureter is visible (black arrowhead) entering the vagina. (Courtesy of the University of Bristol)
Image of 6.89
6.89 Lateral view of the abdomen of an entire bitch during late pregnancy. Two fetuses can be identified. (Courtesy of the University of Bristol)
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6.90 Lateral view of the abdomen of a bitch revealing a gas opacity within and around the fetal sacs, consistent with fetal death. Gas associated with fetal death must be distinguished from overlying gas-filled intestinal loops. (Courtesy of Mandeville Veterinary Hospital)
Image of 6.91
6.91 Lateral views of the abdomen of two entire bitches with pyometra. There is mild uterine enlargement (arrowed). A large pyometra with large, sinuous, homogeneous soft tissue loops (double-headed arrows) fill the mid- and caudal abdomen and should not be mistaken for dilated small intestinal loops, which have been displaced cranially.
Image of 6.92
6.92 Lateral views of the abdomen of two entire bitches with ovarian neoplasia. The mass (arrowheads) lies within the mid-dorsal abdomen and has displaced the small intestine ventrally and peripherally. Ovarian masses should be differentiated from those masses arising from the small intestine or within the mesentery (in particular, lymphadenopathy). The mass (arrowheads) is extremely large and homogeneous, filling the mid-ventral abdomen and displacing the majority of the small intestinal loops cranially. Such a large mass must be distinguished from splenic masses, pedunculated hepatic masses, cystic masses within the mesentery and focal masses within the uterus. (a, Courtesy of G Hammond, University of Glasgow; b, Courtesy of R Hagen)
Image of 6.93
6.93 Lateral retrograde vaginourethrogram of an entire bitch with a vaginal mass. The positive contrast medium outlines the ventral aspect of a large soft tissue filling defect, consistent with a cranial vaginal mass (arrowheads). The cervix (C) is cranially displaced.
Image of 6.94
6.94 Lateral survey radiograph of the abdomen and lateral and VD retrograde vaginourethrograms of an entire bitch with a large vaginal mass. (a) The soft tissue mass (arrowheads) extends cranial to the pelvic brim, displacing the bladder further cranially. (b–c) The mass (white arrowheads) lies to the left and dorsal to the vagina. Indentation and displacement of the vagina by the mass results in a broad but shallow, smoothly marginated filling defect (black arrowhead). U = urethra; V = vagina. (Courtesy of P Mahoney)
Image of 6.95
6.95 Lateral view of the abdomen of a cat with a ventral body wall rupture. The bladder and the majority of the small intestinal loops are displaced ventrally through the defect and lie within the inguinal region. The peritoneal cavity appears ‘empty’ with only the liver, spleen (S), stomach and colon (C) remaining. B = bladder. (Courtesy of the University of Bristol)
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6.96 Lateral survey radiograph of the abdomen of a dog with pneumoperitoneum. A large volume of free abdominal gas, best appreciated in the craniodorsal abdomen, highlights the caudal aspect of the diaphragm (solid white arrow) and the serosal surfaces of the abdominal organs (L = liver; dashed white arrows = cranial serosal surface of liver) and viscera (black arrows = colon and caecum).
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6.97 Left lateral decubitus view used to detect free abdominal gas. The gas has collected in the uppermost part of the abdomen (arrowed) and a fluid line (fluid–gas interface) is present.
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6.98 Lateral view of the abdomen of a dog with pneumoretroperitoneum. There is extension of a pneumomediastinum into the retroperitoneal space. The margins of the cranial abdominal aorta (white arrowheads) and caudal vena cava (black arrowheads), which are not usually visible, can be seen as they are surrounded by gas. The triangular gas opacity in the retroperitoneum surrounds and highlights the left (LK) and right (RK) kidneys. (Courtesy of the University of Bristol)
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6.99 Lateral view of the abdomen of a dog with a small volume of free abdominal fluid. The serosal detail of the abdominal organs (liver) and viscera (small intestine) is blurred (arrowheads).
Image of 6.100
6.100 Lateral view of the abdomen of a cat with a large volume of abdominal fluid. This has resulted in a pendulous appearance to the abdomen and effacement of the margins of all the soft tissue structures. Loops of gas-containing small intestine have floated to the central (upper) part of the abdomen. The retroperitoneal space is not affected and the dorsal margin of one of the kidneys (arrowed) is still visible.
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6.101 Lateral view of the abdomen of a cat with abdominal fluid. Serosal detail has been completely lost. The cat is thin with almost no fat evident within the abdomen. Despite this, the abdominal wall has a slight pendulous appearance, which indicates an abdominal effusion of significant volume.
Image of 6.102
6.102 Lateral view of the abdomen of a dog with severe peritonitis. Serosal detail is blurred (arrowheads), especially ventrally where the greater omentum lies along the ventral abdominal wall. Note that the appearance is very similar to that of the patient with a small amount of free abdominal fluid in Figure 6.99 . (Courtesy of the University of Bristol)
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6.103 Lateral view of a dog with severe mesenteric lymphadenopathy and diffuse neoplastic infiltration of the abdomen. Some of the enlarged lymph nodes in the mid-abdomen are visible as irregularly rounded soft tissue masses (arrowheads). In the ventral abdomen, the masses are more poorly circumscribed and confluent (*) with the spleen (S) located cranioventrally. The serosal margins are blurred due to fluid or infiltrate.
Image of 6.104
6.104 Lateral view of the abdomen of a dog with retroperitoneal haemorrhage from an adrenal gland mass. The retroperitoneal space is enlarged with ventral displacement of the descending colon. Detail within the retroperitoneal space is reduced by a streaky soft tissue opacity (arrowheads) and the left kidney is obscured. The adrenal gland mass itself cannot be distinguished from the kidneys. (Courtesy of P Mahoney)
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6.105 Lateral view of the abdomen of a cat with lymphoma. A large lobulated soft tissue mass (arrowheads) ventral to the caudal lumbar vertebrae is visible, consistent with marked sublumbar lymphadenopathy. The colon is displaced ventrally. (Courtesy of the University of Bristol)

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