C10011303 / invoice 10000

10/03/2026 recheck ALT 136 (10 - 125 U/L)
Alb WNL now 
sedation: torb 0.4ml IV + dom 0.2ml IV to effect 
small amount alfax needed for u cath (6 french) 
traumatic sample of bladder wall (drained bladder first, then small amount saline to visualise cath and polyp/lumps bladder trigone) 

CLINICAL INDICATION
Recurrent urinary tract infection/inflammation, previously noted thickened bladder wall with negative culture, incidental splenic and hepatic lesions on previous scan, and mildly elevated ALT. Metacam for 2 weeks?

FINDINGS
URINARY BLADDER: Largely uniform wall, slightly thickened at 0.06 cm. Contains anechoic contents and tapers normally into the trigone. Three areas of mucosal invagination of the wall are present, measuring 0.61 x 0.55 cm and 0.63 x 0.51 cm. These structures are smooth, homogeneous, hyperechoic, and do not cause shadowing.
KIDNEYS: Right kidney 6.0 cm (alternate measurement 6.6 cm) and left kidney 5.99 cm. Both have smooth borders with a slight loss of corticomedullary definition. Renal pelves are unremarkable.
ADRENALS: Right adrenal 0.46 cm at the caudal pole hypoechoic with smooth borders. Left adrenal is hypoechoic with smooth borders, 0.61 cm at the caudal pole.
SPLEEN: Largely homogeneous. Multiple hyperechoic lesions along the medial border, measuring 0.7 cm, 0.45 x 0.68 cm, and 0.66 cm. One hypoechoic circular lesion in the mid-body measuring 0.96 x 1.02 cm.
PANCREAS: Right limb is slightly heterogeneous. No inflamed mesentery surrounding.
LIVER: Slightly hypoechoic/isoechoic to the spleen. Subtle hyperechoic lesion in the right liver, 1.14 x 1.47 cm, with smooth sharp borders. Heterogeneous lesion in the left caudal liver, 1.09 x 2.58 cm. Subtle hypoechoic lesions in the mid-body, 0.53 cm.
GALL BLADDER: Unremarkable wall. A moderate amount of echogenic sludge is present.
LYMPH NODES: Medial iliac lymph nodes not obvious.
STOMACH: Contains fluid. Normal wall layering and thickness, 0.25 cm and 0.31 cm. Unable to assess PDJ due to shadowing. 
SMALL INTESTINE: Normal wall layering and thickness. Duodenum 0.39 cm. Other intestinal widths 0.38 cm and 0.36 cm.
Free fluid - Not present.
FNA - Spleen (body - not lesion) ; Liver attempted FNA of left caudal lobe lesions + normal liver ; traumatic bladder biopsy as per SW 

Assessment:
1. Recurrent urinary tract infection / haematuria --> 3rd in 5 months ? check. Incontinence with infctn - usually resolves with ABs. 
2. Bladder wall thickening with mucosal invaginations - ddx polyp? vs TCC v ? 
3. Splenic lesions (hyperechoic and hypoechoic) - prev infarct, heamatoma, BNH, EMH, neoplasia probably less likely, infection less likely  
4. Hepatic lesions (heterogeneous (causing mild capsule bulge) and hypoechoic) - BNH, cyst, haematoma, neoplasia primary v mets, EMH, abscess/granuloma, haematoma, thrombosis
5. Mildly elevated ALT

Plan:
FNA samples lesion liver  and spleen - if clear does not fully r/o neoplasia but may rule in 

all samples to vetnostics 
urinary samples in urine pot + edta + slides done 
post op anti-sedan 

call Chailee left VM to pick up after 4.30pm 
await sample results 
SW