1-year-old Female Boxer | American College of Veterinary Radiology

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Air in retroperitoneum and mediastinum
Fluid and air dilated duodenum, readily connected to the pylorus on all views. All jejunal loops normal size.

Duodenal mechanical obstruction
Pneumomediastinum and pneumoretroperitoneum; cause indeterminate (presumably Macklin effect from severe vomiting)

Surgical emergency (based on signalment, neoplastic causes are very unlikely, so staging the abdomen unnecessary)
Stage causes of pneumomediastinum with thoracic radiographs

Candidates consistently misdiagnosed the duodenum as the colon.
50% of candidates never mentioned the word “duodenum” and stopped at testing for causes of pneumoretroperitoneum and pneumomediastinum
25% of candidates discussed the challenge of differentiating between duodenum and colon and tested appropriately for differentiating between colon and duodenum (pneumocolonogram, Abd US) receiving partial points.
25% of candidates labelled the dilated loop as duodenum, therefore proceeded to surgery to receive full points.

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