so this was a really interesting case a six-year-old female neutered imported to the UK from Greece a number of years ago had a previous diagnosis of lyshmoniasis which is being treated with Allopurinol and a recent diagnosis of capillaria Plica which is bladderworm not something commonly diagnosed in the UK so here's what we saw when we were scanning the left kidney so we've got the cortex and the medulla here we can't really see the pelvis area um and that's because it's completely obscured we've got this hyperechoic area casting a um an acoustic shadow beneath it suggesting that we've got mineralization here so we've got a huge nephrolith here and again um same kidney so we've got the cortex out here and then the medulla and then in this pelvis area we've got this enormous nephrolith foreign just Fanning through this left kidney can see this large nephrolith within it seeing it in transverse also Fanning through um we can see this acoustic shadow falling beneath the nephrolith when we were scanning the bladder we found this um structure within it that seemed to have a soft tissue opacity to it um we've got a reasonably thin bladder wall on the outside um so we're wondering whether this could be um a polyp or a tumor from the bladder wall or um what this could be so what we really want to do is assess whether it falls to the gravity dependent side and whether it has any blood flow within it so with this bladder um structure we applied Doppler and we could see there was no flow in it we could assess that it easily fell to the dependent side and given the recent treatment it this dog had had to um treat for bladder worm and we decided that this was likely due to blood clots within the bladder oh so in this case we found nephrolithiasis in both kidneys there was no sign of dilated ureters so it wasn't causing a blockage no dilated pelvis as far as we could see with fluid anyhow allopurinol seemed the likely cause of nephrolithiasis and especially given this paper that I've referred to down the bottom adverse urinary effects of allopurinol in dogs with lychronizes seem to confirm that this is a known side effect and the bladder contained large blood clot there was no blood flow in it and it fell to the dependent side so fairly confident that that was a blood clot in the bladder the dog was referred for surgery to remove the netherolists and they had good success with nephrolith removal as long as it was under six centimeters in length
