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Hematuria

Patient Information

Age
8 Years
Gender
Male, Neutered
Species
Canine

Images

A right ureteral mass is visible obstructing urine flow from the right kidney with mass extrusion or blood clot present in the right kidney pelvis which is severely dilated as a result of hydronephrosis. The lack of color flow in image 3 in the ureter is juxtaposed against the adjacent aorta that reveals a positive color flow signal.
A right ureteral mass is visible obstructing urine flow from the right kidney with mass extrusion or blood clot present in the right kidney pelvis which is severely dilated as a result of hydronephrosis. The lack of color flow in image 3 in the ureter is juxtaposed against the adjacent aorta that reveals a positive color flow signal.
A right ureteral mass is visible obstructing urine flow from the right kidney with mass extrusion or blood clot present in the right kidney pelvis which is severely dilated as a result of hydronephrosis. The lack of color flow in image 3 in the ureter is juxtaposed against the adjacent aorta that reveals a positive color flow signal.
Hi resolution image of the ureteral mass that is isoechoic to surrounding fat. Color flow signals are present in the ureteral tissue owing to the neoplastic blood flow differentiating mass from clot or debris.
The primary portion of the obstructive ureteral mass measures 3.53 x 1 cm.
Postoperative view of the right ureter/mass and hydronephrotic right kidney.
Postoperative view of the right ureter/mass and hydronephrotic right kidney.

History

The patient is an 8 year old, MN, canine Queensland Healer Cross that presented for hematuria. Clinical exam was uneventful. CBC and chemistry panel was unremarkable. Hematuria and evidence of UTI was present in the urinalysis.

Clinical Differential Diagnosis

(Lobetti) Bladder - neoplasia, uroliths, bacterial cystitis, trauma Prostate - neoplasia, abscess Kidney - neoplasia, renolith, pyelonephritis, trauma

Sonographic Differential Diagnosis

(Lindquist): Obstructive right ureteral mass with extension into right renal pelvis and secondary hydronephrosis. Potential pelvic blood clot. Mass appears resectable with right nephro-ureterectomy. Suspect transitional cell carcinoma or sarcoma.

Sampling

(Dr. Doug Casey): US-guided FNA of the ureteral mass revealed epithelial atypia. Surgical biopsy of the right ureteral mass revealed ureteral sarcoma with hemorrhage. Right kidney: Hydronephrosis, pelvic hemorrhage, parenchymal atrophy, fibrosis, mild interstitial lymphoplasmacytic nephrosis.

Outcome

The patient recovered uneventfully. Oncology consultation pending.

Comments

Special thanks to Dr. Doug Casey of English Bay Ultrasound, Vancouver, BC, Canada and Dr Phil Anderson and Staff Animal Care Clinic (http://animalcareclinicvancouver.com) for the excellent management of this case

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