The use of contrast-enhanced ultrasonography for the detection of active renal hemorrhage in a dog with spontaneous kidney rupture resulting in hemoperitoneum

Arterial malformations leading to bilateral spontaneous renal hemorrhage in a dog

OBJECTIVE

To describe the clinical presentation, diagnostic imaging, management, and follow-up of a dog that presented with sequential, bilateral, spontaneous, subcapsular and perirenal hemorrhage (Wunderlich syndrome) due to bilateral renal arterial malformations.

CASE SUMMARY

A 9-year-old intact male Field Spaniel presented for acute onset abdominal pain following a possible syncopal episode. Abdominal ultrasonography, contrast-enhanced ultrasound, and computed tomography (CT) revealed right-sided perirenal hemorrhage that extended into the peritoneum. The dog was discharged following stabilization with analgesia, fluid therapy, and tranexamic acid. One month later, the patient presented with identical clinical signs. A CT scan at this stage revealed bilateral kidney infarcts with new left-sided perirenal hemorrhage. Abdominal ultrasound and contrast-enhanced ultrasound were repeated and showed similar findings. Follow up with four-dimensional CT angiography revealed bilateral renal arterial malformations, likely causing spontaneous renal hemorrhage and secondary subcapsular hematomas , retroperitoneal and peritoneal hemorrhage.

UNIQUE INFORMATION PROVIDED

This is the first reported case of both bilateral renal arterial malformations and bilateral spontaneous subcapsular and perirenal hemorrhage in the absence of neoplasia, coagulopathy, or trauma in a dog. Advanced imaging modalities, including selective angiography, were required to diagnose this condition successfully. Arterial malformations should be considered as a differential diagnosis in cases of hemoretroperitoneum. Nephrectomy due to perirenal hemorrhage should be cautiously considered, especially in the absence of angiography, because of the sequential bilateral nature of this case. Conservative management in this case resulted in a good long-term outcome 10 months later.

Klebsiella pneumoniae infection secondary to spontaneous renal rupture that presents only as fever: A case report

BACKGROUND

Spontaneous renal rupture is a rare disease in the clinic. The causes of spontaneous renal rupture include extrarenal factors, intrarenal factors, and idiopathic factors. Reports on infection secondary to spontaneous renal rupture and the complications of spontaneous renal rupture are scarce. Furthermore, there are few patients with spontaneous renal rupture who present only with fever.

CASE SUMMARY

We present the case of a 52-year-old female patient who was admitted to our hospital. She presented only with fever, and the cause of the disease was unclear. She underwent a contrast-enhanced computed tomography (CT) scan, which showed that the left renal capsule had a crescent-shaped, low-density shadow; the perirenal fat was blurred, and exudation was visible with no sign of calculi, malignancies, instrumentation, or trauma. Under ultrasound guidance, a pigtail catheter was inserted into the hematoma, and fluid was drained and used for the bacterial test, which proved the presence of Klebsiella pneumoniae. Two months later, abdominal CT showed that the hematoma was absorbed, so the drainage tube was removed. The abdominal CT was normal after 4 mo.

CONCLUSION

Spontaneous renal rupture due to intrarenal factors causes a higher proportion of shock and is more likely to cause anemia.

Contrast-enhanced voiding urosonography: A new, radiation-free, alternative method for imaging of urinary bladder and urethra in healthy dogs

Contrast-enhanced voiding urosonography (CE-VUS) has been generally considered as a promising tool to diagnose vesicoureteral reflux and abnormalities in lower urinary tract in human patients, especially in children. The purpose of this prospective study is to evaluate the quality of images of the urinary bladder and urethra obtained by CE-VUS using a second-generation ultrasound contrast agent (SonoVue®) in healthy dogs and to investigate the safety profile of SonoVue® after intravesical administration. Eighty-four CE-VUS examinations with SonoVue® were successfully performed in both unsedated (39/84) and sedated (45/84) dogs. Contrast-enhanced voiding urosonography examination of urinary bladder was technically successful in all (84/84) dogs. The image quality was not considered adequate in five (5/84) dogs including three dogs in whom layering of contrast media during filling phase was observed and two dogs with premature destruction of microbubbles. In these five dogs, the problem was readily recognized and corrected such that the procedure was still successfully undertaken. The assessment of the urethra during spontaneous micturition was successfully performed in all (84/84) dogs in whom voiding was elicited during the examination. No side effects were observed after intravesical application of SonoVue®. This study demonstrates that CE-VUS is a feasible and valuable technique to evaluate low urinary tract morphology and function in dogs. Based on our review of the literature, there are no published reports about the use of this method in dogs.