Imaging Diagnosis – Use of Multiphase Computed Tomographic Urography in the Diagnosis of Ureteral Tear in a 6-Day-Old Foal.

This study explores the application of multiphase computed tomographic urography (CT urography) in diagnosing a ureteral tear in a 6-day-old foal. The diagnosis was made using both ultrasound and CT imaging, and the data collected helped to establish the most appropriate treatment for the animal.

Background Information and Patient Presentation

• The patient, a 6-day old foal, was observed to be depressed and uninterested in eating.
• After stabilizing the foal, the medical team found that she had hypochloremic metabolic alkalosis (a type of acid-base imbalance) and persistent hypercreatinemia (abnormally high levels of creatinine in the blood).
• An ultrasound was conducted, revealing fluid accumulation around the left kidney. They also discovered fluid-filled, rounded structure situated behind the urinary bladder.

Diagnostic Procedure

• To further investigate the issue, computed tomography (CT) was used. The scanning revealed a partial tear in the foal’s left ureter – a condition that could potentially be fatal.
• The CT also showed distension of the retroperitoneal membrane, which is the fibrous layer that separates the organs in the abdominal cavity from the muscles and bones of the lower spine.

Treatment and Outcome

• The diagnosis based on ultrasound and CT imaging guided the veterinarians in selecting the most fitting therapeutic approach. They performed an exploratory celiotomy, a surgical procedure on the abdominal cavity to investigate the problem.
• Considering the damage inflicted, the medical team performed a left kidney nephrectomy; a surgical procedure to remove the kidney. This was necessary due to the severity of the ureteral tear and the subsequent damage to the kidney.
• The surgery was successful and after six months the foal was growing as expected and not experiencing complications from the surgical procedure.

Conclusion

• The combination of ultrasound and computed tomographic urography was pivotal for arriving at an accurate diagnosis.
• This case highlights the significance of these advanced imaging techniques in pinpointing the cause of the symptoms and aiding in devising the best therapeutic approach, which was crucial in saving the life of the foal.