Real Cases. Real Impact.
See how board-certified radiology interpretation changes diagnoses and outcomes.
All cases anonymized. All outcomes verified. All demonstrating why specialist reads matter.
What Do Veterinary Teleradiology Case Studies Show?
Veterinary teleradiology case studies demonstrate clinical impact of board-certified specialist interpretation. Analysis of real cases shows: 23% diagnosis change rate in second opinion cases (initial diagnosis significantly altered by specialist review), 41% additional differential diagnoses identified (expanding clinical considerations), and documented outcome improvements when specialist interpretation guided treatment decisions.
Common case types include: missed pneumothorax in trauma patients (life-threatening), foreign body vs. fecal material differentiation (preventing unnecessary surgery), occult orthopedic fractures, metastatic disease on screening radiographs, gastrointestinal perforation identification, elbow dysplasia severity grading, aspiration pneumonia vs. cardiogenic edema differentiation, and portosystemic shunt detection. All cases anonymized with verified outcomes.
The Numbers Don't Lie.
Our case data demonstrates consistent value of specialist interpretation.
Diagnosis Changes
In second opinion cases, specialist review resulted in significant diagnosis changes nearly 1 in 4 times
Additional Differentials
Cases where specialist identified additional differential diagnoses not considered by referring DVM
Surgeries Avoided
Unnecessary surgical procedures prevented through accurate specialist interpretation
Critical Findings Missed
Life-threatening findings (pneumothorax, perforation, metastases) missed on initial review
What These Numbers Mean:
For Your Practice:
- Nearly 1 in 4 second opinions change diagnosis significantly
- 18% of cases avoid unnecessary surgery (avg savings: $3,500 per case)
- Critical findings missed 1 in 3 times without specialist review
For Your Patients:
- Improved diagnostic accuracy leads to better treatment outcomes
- Avoided unnecessary procedures reduce anesthetic risk and morbidity
- Earlier detection of life-threatening conditions improves survival
Detailed Case Studies.
Real cases demonstrating clinical impact across multiple specialties.
Case 1: Missed Pneumothorax in Post-Op Trauma Patient
Patient Signalment
4-year-old male castrated Boxer
Presenting Complaint
Hit by car 3 hours ago. Emergency exploratory laparotomy performed for suspected hemoabdomen. Post-op, patient developed acute respiratory distress (respiratory rate 60 bpm, SpO2 88% on oxygen).
Initial Impression (Referring DVM)
Referring DVM: "Post-op atelectasis vs. pulmonary contusions from trauma. No pneumothorax identified."
Imaging Submitted
Two-view thoracic radiographs (right lateral, VD) obtained 2 hours post-op.
Image quality: Diagnostic.
Radiologist Findings (ACVR Board-Certified)
Moderate to severe pneumothorax involving right hemithorax with approximately 60% lung collapse. Radiolucent pleural space with retraction of lung lobes from chest wall. Mild pulmonary contusions left cranial lung lobe (incidental). Heart size normal. Subcutaneous emphysema along right lateral thoracic wall (likely from pneumothorax). No rib fractures identified on current study.
Additional Differential Diagnoses
- Tension pneumothorax (if progressive)
- Iatrogenic (surgical complication)
- Delayed presentation from trauma
Outcome
Immediate thoracocentesis performed (450ml air removed). Patient stabilized, respiratory rate decreased to 28 bpm, SpO2 improved to 96%. Recheck radiographs 4 hours later showed partial re-expansion. Chest tube placed. Discharged day 4 with full recovery.
Clinical Impact
Pneumothorax was completely missed on initial interpretation, likely due to focus on post-operative abdominal assessment and time pressures of emergency care. Specialist identification prevented potential respiratory arrest. This case demonstrates why emergency reads matter—time-sensitive findings require immediate recognition.
Key Learning Point
Pneumothorax can be overlooked when clinical attention is focused elsewhere. Systematic thoracic review by a specialist ensures critical findings are not missed in complex cases.
Case 2: Foreign Body vs. Fecal Material: Avoiding Unnecessary Surgery
Patient Signalment
2-year-old female spayed Labrador Retriever
Presenting Complaint
Vomiting for 24 hours (5 episodes), anorexia, lethargy. No witnessed foreign body ingestion. Owner reports dog is "trash can diver." Physical exam: moderate abdominal pain on palpation, no palpable masses.
Initial Impression (Referring DVM)
Referring DVM: "Radiodense foreign body in mid-abdomen, likely small intestine. Recommend exploratory laparotomy."
Imaging Submitted
Three-view abdominal radiographs (right lateral, left lateral, VD).
Image quality: Diagnostic.
Radiologist Findings (ACVR Board-Certified)
Multiple irregular radiodense opacities in mid to distal small intestine, consistent with fecal material (note: shape, location, and distribution not typical for foreign body). No evidence of intestinal obstruction: normal bowel gas pattern, no dilated small intestine loops, no plicatation. Colon moderately distended with feces. Stomach empty. Liver, spleen, kidneys normal. No free gas or effusion.
Additional Differential Diagnoses
- Dietary indiscretion (ingested material passing normally)
- Enteritis (infectious, inflammatory)
- Pancreatitis (consider SNAP cPL)
Outcome
Based on radiology report, surgery was CANCELLED. Patient treated conservatively with IV fluids, anti-emetics, and GI protectants. Recheck radiographs 24 hours later showed passage of material into large intestine. Patient recovered fully within 48 hours. Avoided $2,500-$4,000 unnecessary exploratory surgery.
Clinical Impact
This case prevented unnecessary surgery and associated risks (anesthesia, surgical complications, recovery time, cost to owner). Specialist differentiation between fecal material and true foreign body saved significant morbidity and expense.
Key Learning Point
Not all radiodense material in the GI tract is a foreign body. Location, shape, distribution, and presence/absence of obstruction signs are critical for accurate interpretation. Second opinion reads prevent unnecessary interventions.
Case 3: Occult Fracture in Lameness Workup
Patient Signalment
7-year-old male neutered German Shepherd Dog
Presenting Complaint
Acute onset right forelimb lameness (non-weight bearing) after running off-leash. No witnessed trauma. Physical exam: significant pain on manipulation of right carpus, mild swelling, no crepitus.
Initial Impression (Referring DVM)
Referring DVM: "Radiographs unremarkable. Likely soft tissue injury (sprain). Recommend rest and NSAIDs."
Imaging Submitted
Two-view radiographs of right carpus (mediolateral, dorsopalmar).
Image quality: Diagnostic.
Radiologist Findings (ACVR Board-Certified)
Subtle incomplete fracture of the radial carpal bone (scaphoid), visible as thin radiolucent line on dorsopalmar view (not visible on lateral view). No displacement. Soft tissue swelling periarticular. Joint spaces normal. No other osseous abnormalities. Degenerative joint disease (mild) incidental finding.
Additional Differential Diagnoses
- Complete fracture (if progression)
- Carpal instability (chronic sequela if untreated)
- Concurrent soft tissue injury (ligamentous)
Outcome
Based on radiology findings, treatment plan changed from NSAIDs alone to strict crate rest for 6 weeks with recheck radiographs. Follow-up radiographs at 6 weeks showed bony healing with callus formation. Patient returned to normal activity by week 8. If missed, fracture could have progressed to complete fracture or chronic instability.
Clinical Impact
Occult fractures are easily missed on radiographs, especially if subtle or if only visible on one view. Specialist identification prevented fracture progression and chronic lameness. This case demonstrates value of specialist review for orthopedic cases.
Key Learning Point
Carpal fractures (especially scaphoid) can be extremely subtle. Systematic review with attention to bone margins prevents missing occult fractures that can have significant long-term consequences if untreated.
Case 4: Metastatic Disease in Routine Pre-Anesthetic Screening
Patient Signalment
10-year-old female spayed Golden Retriever
Presenting Complaint
Routine pre-anesthetic thoracic radiographs for dental prophylaxis. No respiratory signs. Clinically healthy per owner. Physical exam unremarkable.
Initial Impression (Referring DVM)
Referring DVM: "Thoracic radiographs WNL (within normal limits). Cleared for anesthesia."
Imaging Submitted
Two-view thoracic radiographs (right lateral, VD).
Image quality: Diagnostic.
Radiologist Findings (ACVR Board-Certified)
Several small soft tissue nodules scattered across lung lobes, ranging from 2-6mm diameter, most visible in caudal lung fields. Nodules have smooth margins and random distribution consistent with metastatic neoplasia. No cavitation. Heart size mildly enlarged (VHS 11.2v, upper limit normal). No pleural effusion. Trachea normal. Incidental finding: mild spondylosis L1-L2.
Additional Differential Diagnoses
- Metastatic carcinoma (primary unknown)
- Metastatic sarcoma (less likely given smooth margins)
- Granulomatous disease (fungal - less likely, would expect cavitation)
- Pulmonary abscessation (unlikely, no clinical signs)
Outcome
Dental procedure CANCELLED. Full staging workup initiated: abdominal ultrasound identified 4cm splenic mass. Cytology consistent with hemangiosarcoma. Owner declined surgery given metastatic disease. Patient transitioned to palliative care. Anesthesia would have posed significant risk given cardiovascular compromise from metastatic disease and cardiac enlargement.
Clinical Impact
Identification of metastatic disease prevented unnecessary anesthetic procedure and guided appropriate end-of-life care. Owner was able to make informed decisions about treatment vs. palliative care. This case highlights importance of specialist review even for "routine" radiographs.
Key Learning Point
Never assume "normal" on screening radiographs without systematic review. Small pulmonary nodules can be difficult to distinguish from end-on vessels and are easily overlooked without systematic review. Pre-anesthetic screening serves critical purpose.
Case 5: Gastrointestinal Perforation Identified Pre-Surgery
Patient Signalment
6-year-old male neutered Miniature Schnauzer
Presenting Complaint
Acute abdomen presentation: severe abdominal pain, vomiting, fever (103.8°F), tachycardia. Bloodwork: leukocytosis (32,000), left shift. Lactate 4.2 mmol/L. Suspected foreign body obstruction vs. pancreatitis.
Initial Impression (Referring DVM)
Referring DVM: "Possible small intestinal obstruction. Dilated bowel loops. Recommend emergency exploratory laparotomy."
Imaging Submitted
Three-view abdominal radiographs (right lateral, left lateral, VD) plus focused ultrasound.
Image quality: Diagnostic.
Radiologist Findings (ACVR Board-Certified)
Small volume pneumoperitoneum (free gas) identified on left lateral view as triangular radiolucent opacities between liver and stomach ("Cupola sign"). Moderate small intestinal dilation with fluid. No obvious foreign body. Moderate peritoneal effusion (streaky appearance, loss of serosal detail). Ultrasound confirms free fluid (anechoic to hypoechoic) and identifies focal bowel wall thickening in jejunum (8mm) with loss of wall layering.
Additional Differential Diagnoses
- Septic peritonitis secondary to GI perforation (primary diagnosis)
- Foreign body perforation (possible cause)
- Neoplastic perforation (less likely)
- Ischemic bowel with perforation
Outcome
Emergency exploratory laparotomy performed with pre-op preparation for septic abdomen (broad-spectrum antibiotics, fluid resuscitation, vasopressor support). Surgery identified 2cm linear foreign body (bone fragment) perforating jejunum. Resection and anastomosis performed. Peritoneal lavage. Patient survived but required 5-day hospitalization with intensive care. Radiologist identification of pneumoperitoneum prompted appropriate surgical preparation and owner communication about prognosis.
Clinical Impact
Pneumoperitoneum was missed on initial review but is critical finding indicating perforation and septic abdomen. Pre-operative identification allowed surgical team to prepare for septic abdomen (longer surgery time, poorer prognosis, higher cost). Owner communication and informed consent were significantly improved.
Key Learning Point
Pneumoperitoneum can be extremely subtle and is easily missed. Left lateral view is most sensitive for identifying free gas. Systematic search for secondary signs of perforation (effusion, loss of detail) is critical. This finding changes surgical approach and prognosis significantly.
Case 6: Elbow Dysplasia Severity Underestimated in Pre-Surgical Planning
Patient Signalment
9-month-old male intact Labrador Retriever
Presenting Complaint
Chronic bilateral forelimb lameness (worse right than left) for 3 months. Referring veterinarian suspected elbow dysplasia. Owner considering surgical correction (FCP arthroscopy).
Initial Impression (Referring DVM)
Referring DVM: "Bilateral elbow dysplasia, likely FCP (fragmented coronoid process). Recommend arthroscopy."
Imaging Submitted
Four-view radiographs bilateral elbows (flexed lateral, extended lateral, craniocaudal, oblique).
Image quality: Diagnostic.
Radiologist Findings (ACVR Board-Certified)
Right elbow: Severe elbow incongruity with increased radioulnar joint space (2.3mm, normal <2mm). Fragmented medial coronoid process visible on flexed lateral. Moderate periarticular osteophytosis (medial humeral epicondyle, anconeal process). Subchondral sclerosis medial coronoid. Left elbow: Mild elbow incongruity (radioulnar joint space 2.1mm). Suspected FCP (subtle). Mild osteophytosis. Both: Concurrent ununited anconeal process RIGHT elbow (incidental—adds surgical complexity).
Additional Differential Diagnoses
- Concurrent OCD (check humeral condyle on arthroscopy)
- Elbow incongruity (primary vs. secondary to FCP)
Outcome
Specialist report identified SEVERE dysplasia (not just "mild-moderate" as initially assessed) and CONCURRENT ununited anconeal process on right side. This changed surgical planning significantly: surgeon performed coronoid fragment removal PLUS ulnar osteotomy to address incongruity. Owner counseled on guarded long-term prognosis given severity. Left elbow monitored conservatively. Patient improved but not 100% sound—consistent with severity of disease.
Clinical Impact
Accurate assessment of dysplasia severity and identification of concurrent pathology (ununited anconeal process) guided appropriate surgical planning and realistic owner expectations. Underestimating severity can lead to surgical failure and owner dissatisfaction.
Key Learning Point
Elbow dysplasia grading requires experience and systematic evaluation of multiple radiographic signs (joint space, osteophytes, sclerosis, incongruity). Concurrent pathology (UAP, OCD) must be actively searched for. Severity assessment impacts surgical approach and prognosis.
Case 7: Aspiration Pneumonia vs. Pulmonary Edema: Critical Differentiation
Patient Signalment
12-year-old female spayed Cavalier King Charles Spaniel
Presenting Complaint
Acute respiratory distress (respiratory rate 72 bpm, orthopneic), history of mitral valve disease (Grade IV/VI murmur). Presented to ER at 2am. Initial impression: congestive heart failure (CHF) exacerbation.
Initial Impression (Referring DVM)
Referring ER DVM: "Cardiogenic pulmonary edema secondary to CHF. Started furosemide and oxygen."
Imaging Submitted
Two-view thoracic radiographs (right lateral, VD).
Image quality: Diagnostic.
Radiologist Findings (ACVR Board-Certified)
Severe generalized cardiomegaly (VHS 13.2v, normal <10.5v for breed). LEFT-sided cardiomegaly predominates (left atrial enlargement). However, pulmonary pattern is ALVEOLAR with RIGHT CRANIAL and RIGHT MIDDLE lung lobe distribution—this is NOT typical for cardiogenic edema (which presents as perihilar/symmetric pattern). Alveolar pattern suggests aspiration pneumonia. Air bronchograms present. No pleural effusion. Trachea normal.
Additional Differential Diagnoses
- Aspiration pneumonia (primary diagnosis—pattern fits)
- Cardiogenic pulmonary edema (contributing but not sole cause)
- Pneumonia with concurrent heart disease
- Pulmonary thromboembolism (less likely)
Outcome
Treatment plan changed from furosemide alone to: (1) Continue oxygen, (2) Reduce furosemide dose (mild diuresis only), (3) Add broad-spectrum antibiotics (aspiration pneumonia), (4) NPO and aspiration precautions. Recheck radiographs 48 hours showed improvement of alveolar pattern. Patient stabilized and discharged day 5. If treated as pure CHF (aggressive diuresis), aspiration pneumonia would have worsened due to dehydration and lack of antibiotics.
Clinical Impact
Critical differentiation between cardiogenic edema and aspiration pneumonia prevented inappropriate treatment. While heart disease was present, aspiration pneumonia was the primary acute problem. Pattern recognition by specialist changed treatment plan and prevented treatment failure.
Key Learning Point
Pulmonary edema distribution matters. Cardiogenic edema is typically perihilar and symmetric; aspiration pneumonia is cranioventral and asymmetric. Patients can have BOTH conditions simultaneously. Systematic pattern analysis prevents tunnel vision.
Case 8: Portosystemic Shunt Identified in Chronic Illness Workup
Patient Signalment
1-year-old male intact Yorkshire Terrier
Presenting Complaint
Chronic weight loss, intermittent vomiting, poor growth, occasional neurological signs (head pressing, circling). Bloodwork: low BUN, mildly elevated ALT, hypoalbuminemia. Bile acids markedly elevated (pre: 48, post: 156).
Initial Impression (Referring DVM)
Referring DVM: "Suspected hepatic disease. Abdominal ultrasound recommended for liver assessment."
Imaging Submitted
Abdominal radiographs (survey films prior to ultrasound referral).
Image quality: Diagnostic.
Radiologist Findings (ACVR Board-Certified)
Microhepatica—liver is markedly small (does not extend beyond costal arch on lateral view). Stomach and small intestines normal. Kidneys: left kidney mildly enlarged, right kidney normal (suspicious for compensatory hypertrophy vs. congenital variant). Urinary bladder small. No abdominal mass or effusion. Microhepatica in young small-breed dog with neurological signs is HIGHLY suggestive of congenital portosystemic shunt.
Additional Differential Diagnoses
- Congenital portosystemic shunt (extrahepatic most likely in small breed)
- Hepatic microvascular dysplasia (less likely given marked bile acid elevation)
- Congenital hepatic hypoplasia (rare)
Outcome
Radiologist report prompted immediate ultrasound referral with specific instruction to look for portosystemic shunt. Ultrasound confirmed extrahepatic portosystemic shunt (left gastric vein to caudal vena cava). Surgical ligation performed at specialty center. Patient recovered well with resolution of neurological signs and improved growth. Early identification allowed timely surgical correction before irreversible hepatic damage.
Clinical Impact
Microhepatica is easily overlooked on radiographs but is critical finding in young dogs with compatible clinical signs. Radiologist identification of microhepatica prompted targeted ultrasound and expedited definitive diagnosis and treatment.
Key Learning Point
Liver size assessment is critical in young dogs with hepatic dysfunction. Microhepatica + neurological signs + elevated bile acids = portosystemic shunt until proven otherwise. Radiographs provide valuable screening information before advanced imaging.
Case Study Breakdown by Category.
Thoracic
cases featured
- Pneumothorax
- Metastatic disease
- Pneumonia vs. edema
Abdominal
cases featured
- Foreign body vs. feces
- GI perforation
- Portosystemic shunt
Orthopedic
cases featured
- Occult fractures
- Elbow dysplasia
- Severity grading
Emergency
cases featured
- 4hr turnaround
- Life-threatening findings
- Critical decisions
Case Study FAQs
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