X- ray of the abdomin

The retroperitoneal space
Is a bit neglected on radiographs. Like the peritoneal space, it’s a potential space that is mostly filled with fat. It contains the kidneys, adrenals, ureters, and most of the bladder. In cats especially, the retroperitonel space is a depot for fat. It makes the kidneys very visible with its nice fat-soft tissue interface. Ureters are rarely seen, but can be visible if they are dilated, or if the animal is pu/pd.
Poor detail in the retroperitoneal space is almost always streaky or mottled. You will see bands of soft tissue opacity running roughly parallel to the spine. I think it’s because the fluid or inflammation tracks along the planes of fat, since the retroperitoneal space is less distensible than the abdomen. What are the causes of poor retroperitoneal detail? Just think of the organs that reside in the space. Hemorrhage can arise from trauma or mass lesions, and urine from ruptured kidney or ureter. Inflammatory conditions such as peritonitis are less likely to cause poor retroperitoneal detail, though you can see localized fluid and hyperechoic fat on ultrasound.
Another differential to keep in mind is ruptured urethra. Since the retroperitoneal space encompasses the bladder, urethral tears in cats can cause urine to track retrograde into the retroperitoneal space. A urethrogram will make this diagnosis

Peritoneal cavity
Poor peritoneal detail as an increase in soft tissue opacity and loss of the fat-soft tissue interfaces that show the serosal surfaces of organs. There is another pattern of poor peritoneal detail, that looks like a mottled or streaky increase in soft tissue opacity within the fat. This presentation has unique causes, and alternate differential diagnoses. The two differential diagnoses that used for the mottled abdomen are a small amount of peritoneal effusion, and carcinomatosis. Generally the abdominal contour is normal with mottled peritoneal detail. That’s because a small amount of fluid will just dissect between some of the fat folds and planes in the mesentery, and is not enough to distend it. Carcinomatosis can produce enough fluid to distend the abdomen, but then it just looks like peritoneal effusion. In its earlier form, it seems to make the omentum and falciform fat edematous, with a small amount of free fluid. This results in streaks or stripes of soft tissue opacity in the normally homogeneous peritoneal space. Here’s the
One of the subtleties of interpreting abdominal radiographs is peritoneal detail. It’s a difficult region to evaluate, since it is the potential space between all the organs. It is normally filled with fat, including the falciform fat ventral to the liver, and mesenteric fat in the omentum. When we say peritoneal detail, we mean that the contrast between fat and the soft tissue of the organs in the abdomen makes the serosal surfaces visible. Poor peritoneal detail is the loss of this fat-soft tissue interface.
Causes of poor peritoneal detail are loss or apparent loss of fat in the peritoneal space. Thin animals have very little fat, so their detail is poor and the organs are not well seen. Animals with peritoneal effusion (hemoperitoneum, transudate, exudate, urine) have more soft tissue (fluid) opacity than fat because of all the fluid. In this case, the serosal surfaces are also not visible.
How do you tell the difference between lack of fat and effusion? The secret is to look at the abdominal contour and skeleton. Young animals have open vertebral physes, and typically have poor peritoneal detail (lack of fat, small amount of peritoneal fluid) until 2-3 months of age. If the animal is thin, the soft tissues over the vertebral column have an undulating or tented appearance, and the abdomen is concave. Conversely, if there is fluid in the peritoneal space, the abdomen will be rounded. If you consider the animal’s age, body condition and abdominal contour, you should be able to determine if poor detail is due to lack of fat or excess fluid.


summary:
Poor peritoneal detail differential diagnoses:

1. Young animal
   
   
   1. lack of fat, small amount of normal fluid
      
   
   
2. Uniform soft tissue opacity, distended abdomen
   
   
   1. Peritoneal effusion (hemoabdomen, uroabdomen, transudate, peritonitis, carcinomatosis)
      
   
   
3. Focal poor peritoneal detail
   
   
   1. Mass
      
   2. Inflammation (pancreatitis, devitalized bowel)
      
   
   
4. Mottled peritoneal detail, no or mild distension
   
   
   1. Small amount of effusion
      
   2. Carcinomatosis
      
   
   
   
   

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