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Nicole Norena, Ryan B. Appleby, Alice Defarges, Lea Mehrkens, Jeff Biskup
Background
The study describes the clinical presentation, imaging diagnosis, and surgical management of a unique case involving a urachal diverticulum with concurrent pyometra in a young, intact female American Bulldog. Urachal anomalies, rare in both humans and animals, are associated with various complications, including bacterial infections and cystitis. This is the first reported case of an abscessed urachal diverticulum concurrent with pyometra in a dog.
Methods
A 10-month-old dog presented with lethargy, inappetence, and hemorrhagic vaginal discharge. Blood tests revealed severe systemic disturbances, including leukocytosis, anemia, and azotemia. Imaging techniques such as ultrasonography and contrast-enhanced computed tomography (CT) were used to diagnose the anomalies. Surgical exploration, partial cystectomy, and ovariohysterectomy were performed, and tissue samples were histologically analyzed.
Results
Ultrasonography identified a distended bladder with thickened walls and heterogeneous contents, alongside uterine distension. CT revealed a fluid-filled urachal diverticulum and a large cystic uterine mass with similar features. Surgery confirmed a necrotic urachal diverticulum and abscessed bladder. Histopathology diagnosed focal cystic endometrial hyperplasia with pyometra and chronic inflammation in the bladder and diverticulum, linked to bacterial infection.
Limitations
This case study focused on a single patient, limiting generalizability. While CT added diagnostic value, the authors acknowledge that ultrasonography alone might suffice for similar cases, raising considerations about resource use.
Conclusions
The concurrent presentation of an abscessed urachal diverticulum and pyometra represents a novel finding in veterinary medicine. The case emphasizes the diagnostic value of imaging in identifying rare anomalies and their complications. Awareness of such presentations can aid radiologists and veterinarians in diagnosis and management of complex cases involving urachal anomalies.
Dorsal (A), sagittal (B), and transverse (C) CT images postcontrast medium administration centered at the level of the urinary bladder
and uterus. At the apex of the bladder is a crescent-shaped-fluid-filled cavity (*), increased in size from the ultrasound examination (Figure 1) which
communicates with the urinary bladder. The bladder (thick arrow) contains some relatively hyperattenuating material, similar in character to the left
uterine horn (thin arrow). The uterine wall is moderately thick (+).
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