so this case concerns a male neutered two-year-old domestic short-haired cat weighing 3.81 kilos the cat had a history of urinary tract disease and the vet had requested a particular focus of the bladder on ultrasound examination so here we have the bladder it's this anechoic organ here so on ultrasound fluid appears black or anechoic where the sound waves don't attenuate much they don't lose much energy aren't reflected through this fluid and therefore the sound waves have a bit more extra energy as they reach this soft tissue Beyond so that that looks a bit brighter and that is an artifact called acoustic enhancement which tells us that there is fluid in this anechoic area we can also see a few Loops of intestine small intestine nearby so this image is taken in longitudinal of the bladder so that means we're looking from the ventral aspect up towards the dorsal spine and we have cranial towards the left and caudal towards the right in the image so now we're Fanning all the way up and then all the way down so we get that full image in sagittal or longitudinal of the bladder as we fan up it continues to be anechoic fluid but as we found down we can see so we're finding up there down we can see this hyperechoic content and not only is it hyperechoic but it also has an acoustic shadow so there's no sound waves passing through that hyperechoic substance now because there's an acoustic shadow so we know there's no sound waves can pass through it and we can therefore say that that is mineralized content within the bladder we can also see a little bit of sediment floating around down there in the gravity dependent part of the bladder now we're scanning in transverse so we've got a transverse view of the colon beyond the bladder and we're Fanning through in transverse that means we've got left the left of the image is down so that's the gravity dependent side and the right of the image is up um off the table so here we can see that now the sediment is on this side of the image here a bit more we can see this sediment falling down towards the table and we can see the acoustic shadow beneath this mineralized sediment so now we're giving the bladder a bit of a shake allotment to help move this sediment and see whether um whether we've actually got uroliths or whether it's all sediment and we can see it floating around so I'm just removing the probe to get that sediment to move and then I can see with this gravity dependent view where I'm looking down through the bladder towards the table and that the sediment is all moving around within the bladder here again I can see the sediment moving around inside the bladder this mineralized sediment giving a bit of allotment with the ultrasound Probe on the cat now to move some of that sediment and now giving it chance just to settle down and to check that we've that it is falling to the gravity dependent view so we're looking um from the the side of the cap that is up the cat is in lateral recumbency we've got the side of the cap that's up um up here and then we're looking down towards the table through the bladder and that is the gravity dependent side and this sediment this mineralized sediment is um settling on the gravity dependent side here's a still image where we can really see the we've got the anechoic bladder this hyperechoic sediment with the acoustic shadow beneath it which tells us that this is mineralized that all the sound waves are being reflected and that it's settled on this gravity-dependent side now I'm measuring for a cystocentesis to see what's that length needle I will need so I can see the needle length up here measuring from the side of the probe that's got the marker in towards the bladder and we can see there the length of needle that we'll require taking an another measurement as the measurement before had a loop of small intestine nearby so just want to avoid that and and choose a a root that avoids the small intestines and here I'm taking a cystocentesis sample we can see the sediment within the bladder and then we can see the hyperechoic needle down here and the tip of it and just withdrawing some urine and then withdrawing the needle from the cat so the fossy within the bladder Lumen are likely crystals they're mineralized they're causing an acoustic shadow an ultrasound guided cystosentesis was performed and this is highly recommended when we find this in the bladder there was no sign of uroliths but to get a an accurate diagnosis and to decide what diet might be necessary what treatment ongoing might be necessary in this case an ultrasound guide is cystocentesis was the required step foreign
