Tympanic membrane perforations cannot be reliably detected using computed tomography based on 15 cadaver dogs.

The integrity of the tympanic membrane is an important factor when deciding treatment and therapeutic recommendations for dogs with ear disease; however, otoscopic examination may be difficult to perform due to features of external ear canal disease or patient compliance. CT is useful for the evaluation of middle ear disease, including cases in which middle ear disease is detected incidentally. The tympanic membrane is detectable using CT, but anecdotally, apparent focal defects or discontinuities of the tympanic membrane are often seen in patients with and without ear disease. The purpose of this prospective, observer agreement study was to determine if perforations of the tympanic membrane are reliably detectable on CT. Fifteen cadaver dogs underwent CT and video otoscopy to verify the integrity of each tympanic membrane. Cadavers were randomly assigned to have the tympanic membranes left intact or to undergo a myringotomy on either the left, the right, or both sides. CT was performed immediately following the myringotomies. Four blinded evaluators evaluated the pre- and post-myringotomy scans for a total of 30 scans (60 tympanic membranes). Average accuracy was low (44%), and interobserver agreement for all four evaluators was fair. Although the tympanic membrane is visible on CT, perforations of the tympanic membrane are unlikely to be accurately detected or excluded. The appearance of an intact tympanic membrane or defect in the membrane on CT should not be used as criteria to guide clinical treatment recommendations based on this cadaver model.

Delayed Urethral Obstruction after Migration of a Ballistic Pellet in an Alpine Wether.

A one-year-old alpine wether was presented for emergency evaluation of stranguria. Diagnostics identified a moderately distended bladder and mild dehydration. Preliminary lateral radiographs identified two metallic structures consistent with projectile pellets in the pelvic and perineal regions and no evidence of radiopaque uroliths. A tube cystostomy was performed, and a contrast urethrogram revealed one of the pellets in the perineal region was in proximity to the urethral obstruction. Subsequent radiography and ultrasound identified the pellet as being within the lumen of the urethra. Examination of the trichotomized skin revealed two scars, including a scar over the paralumbar fossa in the region of the urinary bladder suggestive of a projectile injury. The pellet was removed by a perineal urethrotomy. The patient was able to spontaneously urinate after urethrotomy, passed a tube cystostomy challenge two weeks after surgery, and was discharged. No complications were reported. While uncommon in the veterinary and comparative medical literature, clinicians should consider the potential for projectile pellets to migrate into the urinary tract after initial injury.

The most common types of uroliths larger than 1 mm are readily visible and accurately measured in an in vitro setting mimicking the canine abdomen using digital radiography.

Abdominal radiography is an important diagnostic to detect uroliths. Cystine and urate uroliths were historically characterized as nonmineral opaque on survey radiographs. However, recent research and clinical observations indicate that pure urate and cystine uroliths may be detected with digital radiography. The primary purpose of this prospective, in vitro, diagnostic accuracy study was to determine the sensitivity of digital radiography in detecting cystoliths of varying size and composition. Forty canine uroliths of pure composition (10 each of calcium oxalate, struvite, cystine, and urate), acquired from Minnesota Urolith Center and ranging from 1 to 10 mm, were placed in phantoms of three various sizes and radiographed. The radiographs, including three sets of each urolith separately, were evaluated by three blinded radiologists on two separate occasions. Evaluation included presence or absence of urolith, number of uroliths, and maximum diameter of the urolith(s). For all four types of uroliths and all readers, the specificity and PPV were 100% with an associated very high sensitivity (94.4%-98.9%) and NPV (94.8%-98.9%). Calcium oxalate uroliths were the most accurately measured and struvite were the least accurately measured when compared with the gross measurement. Smaller uroliths were more accurately measured than larger uroliths. Uroliths placed in smaller bladder phantoms were more accurately measured than in larger bladder phantoms. Though accurate measurement of uroliths is complicated by and dependent on numerous variables, our results reveal that urate and cystine uroliths are visualized on digital radiography making them a relevant differential diagnosis when seen clinically.

Australian perspectives on artificial intelligence in veterinary practice.

While artificial intelligence (AI) and recent developments in deep learning (DL) have sparked interest in medical imaging, there has been little commentary on the impact of AI on the veterinarian and veterinary imaging technologists. This survey study aimed to understand the attitudes, applications, and concerns among veterinarians and radiography professionals in Australia regarding the rapidly emerging applications of AI. An anonymous online survey was circulated to the members of three Australian veterinary professional organizations. The survey invitations were shared via email and social media with the survey open for 5 months. Among the 84 respondents, there was a high level of acceptance of lower order tasks (e.g., patient registration, triage, and dispensing) and less acceptance of high order task automation (e.g., surgery and interpretation). There was a low priority perception for the role of AI in higher order tasks (e.g., diagnosis, interpretation, and decision making) and high priority for those applications that automate complex tasks (e.g., quantitation, segmentation, reconstruction) or improve image quality (e.g., dose/noise reduction and pseudo CT for attenuation correction). Medico-legal, ethical, diversity, and privacy issues posed moderate or high concern while there appeared to be no concern regarding AI being clinically useful and improving efficiency. Mild concerns included redundancy, training bias, transparency, and validity. Australian veterinarians and veterinary professionals recognize important applications of AI for assisting with repetitive tasks, performing less complex tasks, and enhancing the quality of outputs in medical imaging. There are concerns relating to ethical aspects of algorithm development and implementation.

Artificial intelligence 101 for veterinary diagnostic imaging.

The prevalence and pervasiveness of artificial intelligence (AI) with medical images in veterinary and human medicine is rapidly increasing. This article provides essential definitions of AI with medical images with a focus on veterinary radiology. Machine learning methods common in medical image analysis are compared, and a detailed description of convolutional neural networks commonly used in deep learning classification and regression models is provided. A brief introduction to natural language processing (NLP) and its utility in machine learning is also provided. NLP can economize the creation of "truth-data" needed when training AI systems for both diagnostic radiology and radiation oncology applications. The goal of this publication is to provide veterinarians, veterinary radiologists, and radiation oncologists the necessary background needed to understand and comprehend AI-focused research projects and publications.

Radiographic evidence of metaphyseal sclerosis secondary to canine distemper virus: 4 cases in juvenile dogs.

BACKGROUND: Metaphyseal sclerosis secondary to canine distemper virus has been described histopathologically, but its radiographic appearance has not been described. OBJECTIVES: Describe the radiographic appearance of metaphyseal sclerosis secondary to canine distemper virus in juvenile dogs as distinct from metaphyseal osteopathy (formerly called hypertrophic osteodystrophy). ANIMALS: Four dogs (2 intact females and 2 intact males) between 2.5 and 4 months of age presented to 2 different veterinary teaching hospitals. METHODS: Retrospective case series in which definitive diagnosis of canine distemper virus based on antemortem positive reverse transcription-polymerase chain reaction (RT-PCR) result or necropsy was required. RESULTS: All 4 dogs were presented for evaluation of neurologic abnormalities, respiratory signs, and lethargy; 2 dogs had gastrointestinal signs and ocular abnormalities. Radiographs on all patients featured multifocal, symmetric, metaphyseal sclerosis, with no evidence of lysis or changes to the adjacent growth plate. The metaphyseal sclerosis was most apparent at the proximal humeral diaphyses and other included long bones. Diagnosis of distemper was confirmed by necropsy (2 of 4 dogs) or positive RT-PCR results (2 of 4 dogs). Three dogs were euthanized because of progressive illness, and 1 dog was lost to follow-up. CONCLUSION AND CLINICAL IMPORTANCE: Identification of metaphyseal sclerosis on radiographs during diagnostic evaluation of young dogs should lead to a clinical suspicion of canine distemper virus infection. Sclerosis identified secondary to canine distemper virus is distinct from the necrosis and inflammation of metaphyseal osteopathy.

Disseminated Mycobacterium genavense infection in a guinea pig (Cavia porcellus): a case report.

BACKGROUND: Mycobacteria are found in many environmental conditions and infect a variety of species, including rodents and rabbits. Guinea pigs are used experimentally as a model for Mycobacterium tuberculosis, but natural mycobacteriosis in guinea pigs has not been reported. CASE PRESENTATION: A 1.5-year-old female guinea pig was found acutely deceased with no premonitory illness. On gross post-mortem examination, multifocal to coalescing, raised, firm, pale tan nodules with discrete, irregular margins were noted over the surfaces of all lung lobes. Histopathology revealed nodules composed of clustered foamy macrophages and multinucleated giant cells containing numerous bacterial rods. Similar bacteria-laden macrophages were noted within sections of the liver, heart, palpebral conjunctiva, duodenum, and cecum. Polymerase chain reaction was performed on tissues collected during post-mortem examination. The 16S rRNA gene product was sequenced and was identical to the Mycobacterium genavense type strain. CONCLUSIONS: To the best of the author's knowledge, this report details the first documented case of Mycobacterium genvaense infection in a guinea pig and a follow up investigation of close-contact animals. Given their experimental susceptibility and this clinical case report, mycobacteriosis should be considered as a differential in guinea pigs exhibiting weight loss in the absence of other clinical signs. With the potential for zoonotic transmission in immunosuppressed individuals, precautions should be taken to safeguard human health in cases of guinea pigs with suspected M. genavense infection.

T2-weighted turbo spin-echo magnetic resonance imaging of canine brain anatomy at 1.5T, 3T, and 7T field strengths.

Post-mortem T2 weighted images of canine heads were acquired at 1.5T, 3T, and 7T. This study aimed to (1) identify anatomical structures of the canine brain using an ultra-high-field magnetic resonance imaging (MRI) (7T) to help to facilitate their localization on high field MRI images (3T and 1.5T), where these structures may appear less well defined and delineated and (2) evaluate the visibility of canine brain anatomical structures on 1.5T, 3T, and 7T MRI images for optimizing clinical utility. Our hypothesis was that the provided subjective image quality comparison at different field strengths may offer a general baseline for canine brain anatomy and may help clinicians evaluate MRI options better. Six canine heads were examined with 1.5T, 3T, and 7T MRI scanners. T2-weighted images were acquired in three orthogonal planes at each field strength using a turbo spin-echo sequence. Fifty neuroanatomic structures were identified and evaluated on the 7T MR images; subsequently, those were found on the 3T and 45 out of the 50 structures were detected on the 1.5T imaging. The structures that were not able to be identified on the 1.5T imaging included the septum pellucidum, oculomotor nucleus, substantia nigra, claustrum, and thalamic nucleus griseus. Images acquired at 7T were subjective of higher spatial and contrast resolution. However, the ultra-high-field images were prone to artifacts at the interface between tissues of different magnetic properties. In conclusion, 3T MR imaging appears to be the best comprise for evaluating canine brain anatomy on MRI with fewer imaging artifacts.

Inter- and intraobserver agreement for CT measurement of mandibular and medial retropharyngeal lymph nodes is excellent in dogs with histologically confirmed oral melanoma.

Mandibular and medial retropharyngeal lymph nodes are routinely evaluated with CT when staging dogs with oral melanomas. While size alone is considered inadequate for detecting nodal metastasis, it is critical in evaluating treatment response, as clinical decisions are based on changes in size. It is common for different radiologists to measure the size of pre- and posttreatment lymph nodes in the same patient. The objective of this retrospective, observer agreement study was to evaluate the inter- and intraobserver agreement in measuring canine mandibular and medial retropharyngeal lymph nodes by a diverse population of veterinary radiologists and trainees. Fourteen dogs with documented oral melanoma and head CT studies identified from records of a single institution were included in this study. North American veterinary radiologists and trainees were recruited to measure the mandibular and medial retropharyngeal lymph nodes; in triplicate. Prior to performing the study measurements, participants completed a training tool demonstrating the lymph node measurements. Overall, interobserver intraclass correlation coefficient (ICC) was 0.961 (95% confidence interval [CI]: 0.946, 0.972) and intraobserver ICC was 0.977 (95% CI: 0.968, 0.983), indicating excellent agreement (ICC > 0.9 considered excellent). Similar findings were noted following sub-analysis for most variables (experience, size, laterality, axis of measurement). These results suggest that follow-up measurement of the long and short axis of the mandibular lymph nodes and short axis of the medial retropharyngeal lymph nodes in the transverse plane, performed by different veterinary radiologists using the same method of measure, should have minimal impact on clinical decision making.

Repeatability and accuracy of a novel, quantitative radiographic method for differentiating normal canine sacroiliac joints from joints with subluxation or luxation: Pilot study.

Canine sacroiliac (SI) joint subluxation or luxation is most commonly diagnosed based on qualitative radiographic assessments. Aims of this two-part, retrospective, diagnostic accuracy, pilot study were to develop and evaluate a novel quantitative method based on measuring the angle between a line connecting the iliac wings and parallel lines across three anatomical landmarks (cranial endplate of L7, caudal endplate of L6, cranial endplate of L6) on a single ventrodorsal radiograph. For the first part of the study, angle measurements from a single observer were compared for 20 normal canine pelvic radiographs and 20 pelvic radiographs with SI luxation or subluxation. Mean values significantly differed between datasets (P < 0.001). The angles for the normal pelves ranged from 0.6° to 1.5°, while abnormal angles ranged from 3.8° to 7.1°. For the second part of the study, a dataset of 25 normal and 25 abnormal canine pelvic radiographs was evaluated using the novel technique by three blinded readers with varying levels of expertise at two different time points. There was excellent reliability among the three readers with an intraclass correlation (ICC) value of 0.90 and an excellent agreement between day 0 and day 30 readings with an ICC value of 0.91. It was also determined that a cut-off angle of 2.0°, using the line parallel to the cranial endplate of L6, provided overall the best accuracy, sensitivity, and specificity to differentiate normal versus abnormal pelves. These findings may be helpful for clinical cases with equivocal diagnoses and for future development of automated diagnostic tools.

Body mapping chart for estimation of percentage of body surface area in mesocephalic dogs.

OBJECTIVE: To create a chart for estimating body surface area (BSA) for use in canine burn victims, similar to the human Rule of Nines. DESIGN: Prospective study, from 2016 to 2017. SETTING: University teaching hospital. ANIMALS: Nine adult, medium-sized, mesocephalic dogs (5 females, 4 males). INTERVENTIONS: Sedated dogs and fresh cadavers underwent full-body computed tomography (CT) scans. A 3-dimensional technique was used to calculate the surface area of specific body parts, as well as the surface area of the whole body. With the obtained measurements, a BSA chart was created. MEASUREMENTS AND MAIN RESULTS: Estimates for percent of total BSA obtained with CT images were as follows: head and abdomen 14%, respectively, neck and each of the thoracic limbs 9%, thorax 18%, pelvic limbs 11% each, and pelvis including the tail 5%. The most considerable differences between dogs and people in respect to the Rule of Nines chart were noticed in the head, the pelvic limbs, as well as in the groin region in people as compared with the pelvic/tail area in dogs. The surface areas of the front legs and thorax were the only body parts that corresponded with that of human body surfaces. CONCLUSIONS: A chart for estimating canine body surface was created. Given the diversity of dog breeds, sizes, and body conformation, our results cannot be generalized to all dogs. Studies of more diverse populations are warranted.

Spontaneous Pneumothorax: Management and Prognosis.

This review article will review treatment and prognosis of spontaneous pneumothorax in dogs and cats. The advantages of surgical and medical management in dogs and cats, as well as current treatment practices, including autologous blood pleurodesis and small-bore chest tubes, will be discussed.

Spontaneous Pneumothorax: Pathophysiology, Clinical Presentation and Diagnosis.

Spontaneous pneumothorax, which may have an acute or insidious onset in dogs and cats, results in respiratory difficulty and has the potential to be life threatening.1-3 Dogs commonly develop spontaneous pneumothorax due to bullae or blebs, while cats typically have underlying inflammatory disease, like feline allergic airway disease. Urgent therapeutic intervention is essential in animals with respiratory distress. The recommended therapeutic strategies are typically different in each of these species due to underlying etiology. The first part of this review article will focus on physiology, clinical presentation, and diagnosis of spontaneous pneumothorax in dogs and cats. Advances in diagnostics, especially the recent utility of point of care ultrasound, will be discussed. The second part of the series will provide an overview of therapeutic options and management of patients with spontaneous pneumothorax, as well as information on prognosis.

Agreement of Magnetic Resonance Imaging With Computed Tomography in the Assessment for Acute Skull Fractures in a Canine and Feline Cadaver Model.

Computed tomography (CT) is the imaging modality of choice to evaluate patients with acute head trauma. However, magnetic resonance imaging (MRI) may be chosen in select cases. The objectives of this study were to evaluate the agreement of MRI with CT in the assessment for presence or absence of acute skull fractures in a canine and feline cadaver model, compare seven different MRI sequences (T1-W, T2-W, T2-FLAIR, PD-W, T2*-W, "SPACE" and "VIBE"), and determine agreement of four different MRI readers with CT data. Pre- and post-trauma CT and MRI studies were performed on 10 canine and 10 feline cadaver heads. Agreement of MRI with CT as to presence or absence of a fracture was determined for 26 individual osseous structures and four anatomic regions (cranium, face, skull base, temporomandibular joint). Overall, there was 93.5% agreement in assessing a fracture as present or absent between MRI and CT, with a significant difference between the pre and post trauma studies (99.4 vs. 87.6%; p < 0.0001; OR 0.042; 95% CI 0.034-0.052). There was no significant difference between dogs and cats. The agreement for the different MRI sequences with CT ranged from 92.6% (T2*-W) to 94.4% (PD-W). There was higher agreement of MRI with CT in the evaluation for fractures of the face than other anatomic regions. Agreement with CT for individual MRI readers ranged from 92.6 to 94.7%. A PD-W sequence should be added to the MR protocol when evaluating the small animal head trauma patient.

Features of a rare peripheral primitive neuroectodermal tumour arising from the thoracic spine in a juvenile canine patient.

Peripheral primitive neuroectodermal tumours are rare tumours in juveniles. The current patient was a paraplegic 8-month-old Scottish deerhound with a suspected pulmonary mass. Radiographically, there was a large extrapleural mass within the mid-left hemithorax. On MRI, the mass was mainly hyperintense on T2-weighted images, isointense on T1-weighted images and was heterogeneously strongly contrast enhancing with a multilobulated appearance, spinal cord compression, paraspinal musculature invasion and intrathoracic extension. Those changes were confirmed on post-mortem, and the mass diagnosed based on immunohistochemistry.

Small intestinal enterolith in a dog presenting for a suspected gastric foreign body.

A 12-year-old Labrador Retriever presented for an acute onset of anorexia and vomiting. Abdominal ultrasound and abdominal radiographs were performed, and on the latter a large mineral opaque structure with concentric rings within the cranial abdomen was diagnosed as a gastric foreign body. Laparotomy revealed that the suspected gastric foreign body was a large enterolith within the small intestines. Enteroliths should be considered as one of the differential diagnoses for a large mineralized abdominal structure in a dog presented for gastrointestinal clinical signs.

Evaluation of a microvascular anastomotic coupler for end-to-side arterial and venous anastomosis for feline renal transplantation.

OBJECTIVE: To describe the technique and determine the feasibility of an end-to-side (ETS) anastomosis of the renal vein to vena cava and renal artery to aorta using a microvascular anastomotic coupler (MAC) for feline renal transplantation. STUDY DESIGN: In vivo experimental study. ANIMALS: Six purpose-bred domestic shorthair cats. METHODS: The left kidney was autotransplanted using a MAC for ETS vascular anastomosis. Outcomes included intraoperative hemorrhage from the anastomosis sites, duration of anastomoses, surgical complications, postoperative renal perfusion (including resistive index (RI)) measured by Doppler ultrasonography and computed tomography angiography, and histopathological examination of the left kidney and anastomosis sites (30 days). RESULTS: Anastomosis was successful in all cats, and intraoperative hemorrhage was negligible. Intraoperative renal perfusion was considered excellent. Venous and arterial anastomoses were completed in 11 minutes 20 seconds (range, 6:38-13:27) and 21 minutes 50 seconds (range, 11:05-30:24), respectively. Vascular occlusion time was 32 minutes (17:43-42:03). One cat was euthanized 5 hours postoperatively because of bleeding from a muscular arterial branch of the dorsal aorta causing hemoabdomen. Renal perfusion and RI of the remaining five cats were within normal range (<0.8) and similar to the contralateral kidney at all time points. Endothelialization of the anastomosis was complete with mild-to-moderate fibrosis surrounding the MAC in all cats. CONCLUSION: End-to-side anastomosis of the renal vein and artery to the vena cava and aorta, respectively, was consistently achieved in all six cats with the MAC. CLINICAL SIGNIFICANCE: The use of the MAC may be considered as an alternative to hand suturing for ETS anastomoses for feline renal transplantation.

Use of color-coded, three-dimensional-printed equine carpus models is preferred by students but does not result in statistically different academic performance.

Radiology can be a challenging subject for students and finding new techniques that help improve their understanding could have positive effects in their clinical practice. The purpose of this prospective experimental study was to implement the use of color-coded, three-dimensional-printed, handheld equine carpus models into a radiographic anatomy course and evaluate the impact objectively and subjectively using quizzes and student response surveys. A first-year veterinary class was randomly divided into two similarly sized groups (groups A and B) for an equine normal radiographic anatomy laboratory. Both groups experienced the same laboratory structure; however, each student in group B received a handheld three-dimensional-printed equine carpus. Both groups received a quiz at the end of their laboratory consisting of 10 multiple-choice questions related to the equine carpus. An anonymous survey regarding the laboratory was emailed to students after the laboratory. One week later, the same 10 questions in randomized order were administered via a pop-quiz. Students believed both quizzes would count toward their final course grade. There was no statistically significant difference in grades between groups on either quiz (P > .05). However, based on survey responses, group B students felt the carpus made the laboratory more enjoyable and improved their comprehension of the material, whereas group A students felt the carpus would have increased their enjoyment and improved their comprehension. The implementation of three-dimensional-printed anatomic models may be useful to enhance enjoyment and perceived comprehension of veterinary students; however, there is currently insufficient evidence to suggest these models improve academic performance.

Artificial intelligence evaluating primary thoracic lesions has an overall lower error rate compared to veterinarians or veterinarians in conjunction with the artificial intelligence.

To date, deep learning technologies have provided powerful decision support systems to radiologists in human medicine. The aims of this retrospective, exploratory study were to develop and describe an artificial intelligence able to screen thoracic radiographs for primary thoracic lesions in feline and canine patients. Three deep learning networks using three different pretraining strategies to predict 15 types of primary thoracic lesions were created (including tracheal collapse, left atrial enlargement, alveolar pattern, pneumothorax, and pulmonary mass). Upon completion of pretraining, the algorithms were provided with over 22 000 thoracic veterinary radiographs for specific training. All radiographs had a report created by a board-certified veterinary radiologist used as the gold standard. The performances of all three networks were compared to one another. An additional 120 radiographs were then evaluated by three types of observers: the best performing network, veterinarians, and veterinarians aided by the network. The error rates for each of the observers was calculated as an overall and for the 15 labels and were compared using a McNemar's test. The overall error rate of the network was significantly better than the overall error rate of the veterinarians or the veterinarians aided by the network (10.7% vs 16.8% vs17.2%, P = .001). The network's error rate was significantly better to detect cardiac enlargement and for bronchial pattern. The current network only provides help in detecting various lesion types and does not provide a diagnosis. Based on its overall very good performance, this could be used as an aid to general practitioners while waiting for the radiologist's report.

Imaging and clinical features of a true gastrogastric intussusception in a dog.

An 18-month-old male mixed breed dog was evaluated for acute vomiting and hematemesis. Clinical signs and initial radiographic findings shared commonalities with reported cases of pylorogastric intussusception in dogs. However, unlike previously reported cases, additional imaging [including ultrasound and computed tomography (CT)] revealed invagination of the gastric fundus into the gastric body, consistent with true gastrogastric intussusception. These findings were confirmed with histopathology and on necropsy. Key clinical message: Although extremely rare, gastrogastric intussusception should be included as a differential diagnosis for any patient presenting with acute vomiting, abdominal pain, dehydration, or tachycardia in combination with the diagnostic imaging findings described in this report.

Caractéristiques cliniques et d'imagerie d'une intussusception gastro-gastrique vraie chez un chien. Un chien mâle de race croisée âgé de 18 mois fut évalué pour des vomissements aigus et de l'hématémèse. Les signes cliniques et les trouvailles radiographiques initiales partageaient des similarités avec des cas rapportés d'intussusception pyloro-gastrique chez des chiens. Toutefois, contrairement aux cas rapportés précédemment, des examens d'imagerie supplémentaires [incluant l'échographie et la tomodensitométrie (CT)] ont révélé une invagination du fundus gastrique dans le corps de l'estomac, compatible avec une intussusception gastro-gastrique vraie. Ces données furent confirmées lors de l'examen histopathologique et de la nécropsie.Message clinique clé :Bien qu'extrêmement rare, l'intussusception gastro-gastrique devrait être incluse dans le diagnostic différentiel pour tout patient présenté avec des vomissements aigus, de la douleur abdominale, de la déshydratation ou de la tachycardie en combinaison avec les trouvailles en imagerie diagnostique décrites dans le présent rapport.(Traduit par Dr Serge Messier).