Radiographical Assessment of the Urinary System Diseases in Cats

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1 Radiographical Assessment of the Urinary System Diseases in Cats Vlad TIPIŞCĂ 1), Leonardo MEOMARTINO 2), Laura CORTESE 3), Giuseppina MENNONNA 2), Cristina BARBAZAN-ŞERBAN 1), Andrei BĂISAN 1), Constantin DARABAN 1), Elena GAVRILAŞ 1), Vasile VULPE 1) 1) University of Agricultural Sciences and Veterinary Medicine Ion Ionescu de la Brad Iaşi (Romania); 2) Interdepartmental Centre of Veterinary Radiology, Federico II University Napoli (Italy): 3) Department of Veterinary Medicine and Animal Productions, Federico II University Napoli (Italy); Corresponding author, Print ISSN ; Electronic ISSN Abstract The urinary system is frequently diseased in cats. Although the radiographical technique is not the best choice for studying most of the urinary organs, it still remains a valuable tool particularly for ureteral, urinary bladder and urethral disorders. This study aims to describe the aspects of urinary tract pathologies in cats with different urinary diseases, radiographically diagnosed. Twenty-two cats were included in the study after a revision of the database of Interdepartmental Veterinary Radiology Centre of Naples and of Veterinary Radiological Laboratory of Iasi, in the period Survey and contrast medium radiographs were taken in consideration. The diagnosis of the subjects included was also confirmed with other techniques (i.e. ultrasonography, surgery and/or necropsy). Pathological findings that were diagnosed on survey radiographs included: changes in kidney size (2), renal and ureteral lithiasis (3), urinary bladder distension (4), and urinary bladder lithiasis (2).With contrast radiography (i.e. excretory urography and cystography), it was possible to diagnoserenal ectopia with fusion (1), cysts (1), and hydronephrosis (1), dilatation (2), and incompetence (1), urinary bladder cystitis (4) and tumors (2), and urethral stenosis (2). Considering the relative small number of cases, the present study, confirmed that the radiographical technique is not the best choice to image the urinary tract diseases. However, especially when accompanied by contrast studies, radiography demonstrates to be a reliable tool to diagnose urinary pathologies and it still maintains its importance, particularly when other techniques are not available. Keywords urinary system, radiography, cat INTRODUCTION The urinary system is frequently diseased in cats. Although the radiographical technique is not the best choice for studying most of the urinary organs, it still remains a valuable tool particularly for ureteral, urinary bladder and urethral disorders. (Meomartino and co. 2005, Vulpe V. 2003) Renal diseases are common in cats, and Imaging is an integral part of the diagnostic workup of these patients. (Elliot and co.). Radiographic imaging may allow assessment of the relationship existing between the urinary tract diseases and clinical signs. However, survey radiographs may not provide adequate morphologic information when the patient is emaciated or has retroperitoneal fluid. (Meomartino and co.2005, Dennis and co., 2010) This study aims to describe the aspects of urinary tract pathologies in cats with different urinary diseases, radiographicallydiagnosed.

2 226 TIPIŞCĂ et al MATERIALS AND METHODS Twenty-two cats were included in the study after a revision of the database of Interdepartmental Veterinary Radiology Centre of Naples and of the Veterinary Radiological Laboratory of Iasi, in the period Survey and contrast medium radiographs were taken in consideration. The diagnosis of the subjects included was also confirmed with other techniques (i.e. ultrasonography, surgery and/or necropsy). The radiographic studies were performed using the Basic Intermedical 400 (IMD S.p.a. Scanzorosciate-BG-Italy) with conventional film developer and the Euromed 400 (Eurocolumbus, Milano) with an Agfa CR-X30 system. For contrast radiographs, the iodinated contrast media Iopamidol (Iopamiro370- Branco, Milano) and Ioversol (Optiray 350- Mallinckrofdt Medical Imaging Ireland) were used. RESULTS Pathological findings that were diagnosed on survey radiographs included: changes in kidney size (2), renal and ureteral lithiasis (3), urinary bladder distension (4), and urinary bladder lithiasis (2). On contrast radiographs (i.e. excretory urography and cystography), it was possible to diagnose renal ectopia with fusion (1), cysts (1), and hydronephrosis (1),ureteral dilatation and incompetence (3), urinary bladder cystitis (4) and tumors (2), and urethral stenosis (2). The fig 2,3 are illustrating 2 cases of changes in kidney size. Fig 2 shows an enlarged kidney of a 2 years old british short hair cat with polichistic kidneys, confirmed ecographically, and the second case the 11 years old cat with a small sized kidney, diagnosed after with an end stage kidney. Small kidneys are usually the result of chronic renal disease,and the kidney is called end stage kidney. In case of small regular shaped kidneys, hypoplasia can be suspected (Kelly and McAllister, 2005) Fig. 1 Sample composition

3 Radiographical Assessment of the Urinary System Diseases in Cats 227 Fig. 2. VD abdominal radiograph of a 2 years old british short-haired male cat withenlarged right kidney (polycystic kidney) Fig. 3. Lateral radiograph of a 11 years old female cat with right small sized kidney (arrows) Renal lithiasis The case in figures 4 and 5, show severe renal asimetry, caused by small sized right kidney with a compensatory nephromegaly of the left one. On the medial side of the left kidney at the hylus level, a radioopaque calculus is present (arrows). Fig. 4. VD abdominal radiograph of a 6,5years old male neutered cat, with a renal stone. Right kidney is hardly appreciable Fig. 5. Lateral radiograph of the same subject in the previous figure. The renal stone is pointed out by aroow. Right kidney is hardly appreciable.

4 228 TIPIŞCĂ et al Ureteral lithiasis The above placed abdominal radiographs of a 7 years old male cat, show the enlargement of both kidneys, and on the uretheral areas two small radioopaque calculi (arrows). The subsequent ultrasonographic exam demonstrated bilateral hydroneohrosis and confirmed ureteral lithiasis. Ureteral calculi are very rare, but a small calculus, passing down from the kidney to the bladder, may obstruct the ureter (Elliot et al., 2007) Fig. 6. VD abdominal radiograph of a 7years old male cat with ureteral lithiasis (arrow) Fig. 7. Lateral radiograph of the same subject in the previous figure. Two small calculi are visible (arrows) Urinary bladder distension In the case showed in figure 8, the urinary bladder distension, asociated to the fecal constipation, was present in a subject with toraco-lumbar neurologic. In figure 9 the urinary bladder distension is clearly asociated to the severe lumbo-sacral spondylopathy. Fig. 8. Lateral abdominal radiographs of a 8 years old male cat with bladder distension (and fecal constipation) Fig. 9. Close up of a lateral abdominal radiographs of a 14 years old neutered male cat with bladder distension caused by lumbo-sacral spondylopathy

5 Radiographical Assessment of the Urinary System Diseases in Cats 229 Urinary bladder lithiasis Most of the urinary bladder calculi in cats have a struvite chemical composition and are radioopaque 4. Figures 10 and 11 show two exemples of radioopaque calculi in the bladder. A careful examination was necessary to detect the small sized calculi in the case presented on figure 11. Fig.10. Lateral abdominal radiograph of a 3,6 years old neutered male cat with a urinary blader calculus Fig. 11. Lateral abdominal radiograph of a 8 years old neutered female cat with bladder microlithiasis (arrows) Renal ectopia with fusion Renal congenital malformations are rare. Among those, renal hypoplasia is the most common. Renal ectopia is a rare malformation in which one or both kidneys are anatomically misplaced and usually fused. 5 A case of renal ectopia with fusion is shown in Figure 12. Fig. 12. Lateral abdominal contrast radiograph (performed 30 minutes after contrast administration ) of a 11 years old female cat with renal ectopia with fusion Hydronephrosys and ureteral dilatation The excretory urography of the 1 year old neutered female cat presented in Figures 13 and 14, revealed a normal pyelographic phase on right kidney, while persistent nefrographic phase is evident on the left kidney. The ureters except a part of the left one, wich appeared dilatated, cannot be visualized. The radiographyc diagnosis of hydronephrosis was confirmed by subsequent CT and ultrasonographic studies.

6 230 TIPIŞCĂ et al Fig. 13. Lateral excretory urography of a 1 year old neutred female cat with left hidronephrosis Fig. 14. VD excretory urography of the same subject in the previous figure Renal chysts Renal cysts represent the typical lesion of the polycystic disease and from a number of degenerative diseases in cats. Excretory urography is able to visualize the cystic lesion as rounded contrast filling defects on kidney nephrogaphic phase. The renal cyst presented in Figure 15 was ultrasonographically confirmed. Fig. 15. VD excretory urography of a 5 years old female cat 15 minutes after administration. A rounded defect is visible on the left kidney (arrows)

7 Radiographical Assessment of the Urinary System Diseases in Cats 231 Ureteral incompetence The ureteral incompetence is ocasionaly diagnosed during the performing of a retrograde positive contrast cystography, as in the case presented in Figures 16 and 17. The ureteral incompetence causes vesico-ureteral reflux which in young cats could be normal, in adults could lead to ascending pyelonephritis. (Meomartino and co. 2005) Fig. 16. VD retrograde positive cystography in a 13 years old neutered male cat. The right pelvis is filled by contrast medium due to the ureteral incompetence. Fig. 17. Lateral retrograde positive cystography of the same subject in the previous figure. The right pelvis and ureter are filled by contrast medium (white arrows). There is also a slight filling defects of the urinary bladder due to an initial carcinoma (black arrows) Cystitis and urethral stenosys Fig years old male cat with urethral stenosis and cistitis

8 232 TIPIŞCĂ et al Urethrography represent the more sensitive technique for studying the urethra in the cat. Urethral lesions have frequently an iatrogenic origin as in the subject depicted in Figure 18, a 3 years old neutered male cat affected by the feline low urinary tract disease (FLUTD), in which the urethral stenosis was subsequent to repeated catheterizations. Cystitis is a very common disease in cats. The diagnosis is usually made by ultrasonography. However, the retrograde positive contrast (or double contrast) cystography could give some important findings like the irregular and circumferential filling defect of the bladder lumen due to the thickened mucosa (see the Figure 19) or, often as an incidental finding, an associated bladder diverticulum (see the Figure 20). Fig. 19. Lateral retrograde positive cystography of a 1 year old male cat with cystitis Bladder tumors Although ultrasonography is recommended, cystography still remains the unique technique able to clarify the exact relationship between tumor and bladder walls. The case depicted in the Fig. 20. Lateral retrograde positive cystography of a 3 years old male cat with cystitis and bladder diverticulum Figure 21 shows a discrete filling defect localized at the bladder fundus that, compared to the case of Figure 17, showing a lesser pronounced filling defect at the bladder pavement but with a wider extension, has a more favorable prognosis. Fig. 21. Lateral retrograde positive cystography of a 6 years old male cat affected by a bladder carcinoma localized at the fundus (arrow)

9 Radiographical Assessment of the Urinary System Diseases in Cats 233 CONCLUSIONS Considering the relative small number of cases, the present study, confirmed that the radiographical technique is not the best choice to image the urinary tract diseases. However, especially when accompanied by contrast studies, radiography demonstrates to be a reliable tool to diagnose urinary pathologies and it still maintains its importance, particularly when other techniques are not available. REFERENCES 1. Meomartino L. (2005). Addome dei piccoli animali: tubo digerente, pancreas, apparato urinario e surreni. In: Bertoni G., Brunetti and Pozzi L.. Radiologia Veterinaria, Idelson Gnocchi,. 2. Dennis R., Kirberger M.R., Barr F., Wrigley R.H. (2010) Handbook of Small Animal Radiology and Ultrasound, Ed. Elsevier,. 3. Kelly J.K., McAllister H. (2005) Diagnostic Radiology and Ultrasonography of the Dog and Cat, Saunders. 4. Elliot J., Gregorz F. Grauer (2007) BSAWA Manual Of Canine and Feline Nephrology and Urology, BSAVA. 5. Seyrek-Intas D., Kramer M. (2008). Renal Imaging in Cats, Veterinary Focus, 18(2) 6. Vulpe V. (2003) Semiologie Medicală Veterinară : Vol.II : Semiologie Speciala Ed. PIM Iaşi.