suspect acute on chronic pancreatitis in large breed dog

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suspect acute on chronic pancreatitis in large breed dog

Tucker, 11 1/2 yr MN Golden Retriever, has been intermittently vomiting and having diarrhea for the last month.  Cachectic in appearance.  Opportunity for diet indiscretion.  Hx of skin allergies.  Blood work and abdominal rads unremarkable other than no stress response.  ACTH stim pending.  Only T4 run and was 1.5, still WNL. 

Tucker, 11 1/2 yr MN Golden Retriever, has been intermittently vomiting and having diarrhea for the last month.  Cachectic in appearance.  Opportunity for diet indiscretion.  Hx of skin allergies.  Blood work and abdominal rads unremarkable other than no stress response.  ACTH stim pending.  Only T4 run and was 1.5, still WNL. 

I appologize for only one marginal image (having some machine problems – ugh), but my impression of this dog’s left pancreatic limb is that it is more prominent and heterogenous than I would expect and there is mild hyperechoic fat surrouding.  I did not appreciate changes in the right limb.  Just wondering your feedback regarding the image provided? Rest of ultrasound was very unremarkable. 

Comments

EL

Tough on one image as you

Tough on one image as you know and this would seenm to be the right pancreatic limb given the sotmach in the near field in long axis. It is uniform but a bit nebulous at the periphery with ill-defined fat (arrow) but would need to confirm with video. The body of panc echogenicity is distinctly hypoechoic but it will do that with the stomach in the near field. If painful on imaging (+Murphy sign) then I would buy low-grade pancreatitis but I have learned to never ever make a dx on a still. You will be wrong most the time on stills only hence the problems that plagued telemedicine before band width caught up to video thank goodness…. and now SDEP is possible:)  (http://www.sonopath.com/products/downloadable)

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