10 yo Maine Coon mix. Ultrasound for elevated liver enzymes (ALT 555) on preop labwork, doing well at home, vomits bile every other day. T4 pending.
Spindle cell sarcoma removed 3 times from the tail. Last surgery a year ago.
Liver looked fine, guts, pancreas, too.
1) 7mm complex anechoic nodule with a hyperechoic center, distorting the margins, in the cortex of the left kidney, near the cranial pole. No blood flow. Is that a complex cyst? A stone going the wrong way or an emerging neoplasia?
10 yo Maine Coon mix. Ultrasound for elevated liver enzymes (ALT 555) on preop labwork, doing well at home, vomits bile every other day. T4 pending.
Spindle cell sarcoma removed 3 times from the tail. Last surgery a year ago.
Liver looked fine, guts, pancreas, too.
1) 7mm complex anechoic nodule with a hyperechoic center, distorting the margins, in the cortex of the left kidney, near the cranial pole. No blood flow. Is that a complex cyst? A stone going the wrong way or an emerging neoplasia?
2) Small hyperechoic round structure appears to be in the wall of the trigone or below it, surrounded by anechoic round area. Stone? granuloma? Tumor?
Thanks for your input!
Comments
That nodule looks solid to me
That nodule looks solid to me and it looks like there is some mineralization associated with it with some capsule distortion. I am concerned about a primary or metastatic neoplasia given the history. Coag panel and 25 ga FNA of the nodule which appears to be accessible to FNA is suggested.
The small lesion in the cystourerthral junction looks like it might have some pinpoint mineralization as well. Benign lesion like focal, chronic inflammation or emerging neoplasia possible. Cytospin / cytology of a urine sample may be considered to assess for abnormal transitional cells.
Great idea on the urine
Great idea on the urine sediment. Super easy to do. I will tell the rDVM and will update the post once we recheck in a month.
I’m not sure I am comfortable poking the nodule. I’m worried it may rupture and bleed! I’m a big chicken!
Thank you so much for your input!
Julie
Im wondering if that renal
Im wondering if that renal nodule is a cyst as in pkd… any prior ultrasound of the kidney? Also I have seen recent stone movers get abscesses or clots after infarcts that may do this. Im wondering if that stone is in the left u pap in a collpased bladder?… maybe stone moved from LK formed the clot/cyst/infarct and is now embedded in the left u pap? 25g needle in the renal lesion tells the whole story here especially if the owners are thinking of pulling the plug because of potential sarcoma met to the kidney and remember mets usually travel in numbers and not singularly … they usually bring a posse of pals to the party.
Side note try to get the “chicken” out of ya Julie tough to kill anything with a 25g needle:) Soft fna and direct pressure for 3 min post sample. Gotta needle up on these as it makes a big difference sonographer being at least fna capable vs not… too much guesswork without cytology to support the clinical sonography suspicions. I’ve been wrong way to many times that my needle found something different than suspected over the last 25 years. A few hours with needles and a cadaver will change your clinical life for the better forever and enhance your clinical accuracy as you can macthe the needle trajectory with the cytological description so always video capture your sampling then watch the video while you read the cyto report… not the dx but the cellular description. This was the best thing I ever did in my curve to enhance my clinical accuracy and suspected dx. But cant get there without needles.
With a solid cytologist like ours in our telecyto service the need for core biopsy has dropped off significantly unless really looking for structural pathology. Cyto gets us dx or rule out badness in 90+% of our cases so my bx needles sit in my truck most the time compared to the past when i core bx’d everything because of nebulous cyto reads on what i knew was solid samples and presentations. In addition, pet owners go forward with fna much easier than bx for cost and just dont like the idea of tissue cutting but they are usually fine with an “acupuncture needle” like a 25g and Ill put a 25g in anything. Just some encouragement from experience.
Hi Eric,
Yes, really good
Hi Eric,
Yes, really good input on the possible stone in the distal left ureter, and the possible cyst/absces or infarct from a stone.
Thanks for all the advice to get the chicken out! I have come a long way. I am now comfortable with pancreas, spleen, when before I would only do liver and Ln. lol, really true about the 25G needle and its safety. I make phantoms to practice, but olives don’t breathe, so it’s always easier in the phantom!
I have a good local cytologist, who lets me resubmit when my samples are not the best. He picks up the samples in front of my house.
I will update the post once I recheck. Thanks again! I promise to work on the chicken, and remember that 25G needles are pretty much acupuncture needles..
Julie
awesome! I think you will
awesome! I think you will find that 25g gives you a smaller but higher quality sample as well if you have been using anythign larger…. just corkscrew technique the needle if jab doesnt allow exfoliation.
I normally use a 22G for all
I normally use a 22G for all except pancreas. Do you use 25G 1.5 inch needles? Or a regular 25G? I didn’t know they made the 1.5 inch 25G, but I see them on Amazon.
25g x 1.5…. long red
25g x 1.5…. long red needles. I used to use 22 for everything and now only use it for dense tissue like a chronic reactive Ln or fibrotic liver that should have bx anyway but the owner will only do fna or if u need fluid tissue mix for culture then 22 or even 20 x 1.5 is good.
great! I’m buying the 25 G
great! I’m buying the 25 G 1.5 now. Happy to use a smaller needle anyway!
Is that because there is less hemo-dilution?
yes hemodilution and i just
yes hemodilution and i just get less damaged cells as does my team. Attached is what we target for a clean 25 smear.
Julie FYI I updated the title
Julie FYI I updated the title and title image to reflect the discussion and make it searchable for the community in the forum search box if they are interested in fna discussion.
Thank you!
Thank you!
Nice FNA discussion! Good
Nice FNA discussion! Good info, thanks. 🙂
-Karen