Barron, 17y MN DSH, is here for an ultrasound today to evaluate a cranial abdominal mass seen on radiographs. Barron has not been eating well for last couple of weeks. Had a dentistry last week in hopes oral disease may contributing to the anorexia, but anorexia persists. Mirtazipine was started yesterday and he did eat this am. Blood work was unremarkable – mild inc. in BUN, high normal T4, normal coags.
Barron, 17y MN DSH, is here for an ultrasound today to evaluate a cranial abdominal mass seen on radiographs. Barron has not been eating well for last couple of weeks. Had a dentistry last week in hopes oral disease may contributing to the anorexia, but anorexia persists. Mirtazipine was started yesterday and he did eat this am. Blood work was unremarkable – mild inc. in BUN, high normal T4, normal coags.
Brief exam today revealed a systolic heart murmur. No arrythmia ausculted and lungs are clear. Weight 4.34 kg, Temp 100.7, HR 184, mm – pink, CRT 1.
The pancreas is very abnormal on ultrasound with hyperechoic and mottled parenchyma and cystic mass effect dorsally measuring up to 4.4 x 2.6 cm. The portal vein appears to be going through the cystic region. The dorsal stomach wall is in close proximity, but does not appear to be attached to the cystic appearing mass.
There is a hyperechoic liver nodule in the left lobe w/ a cystic region more dorsal and vasculature present within the nodule and the edge of the cystic region.
Performed FNA of the liver today. Pending results, will plan to use heavier sedation and perform drainage of cystic structures, followed by fluid analysis and cytology. Opted this route as concern about vasculature coursing through the cystic region and will want to keep him hospitalized for most of the day following the drainage to monitor for any complications.
My rule outs include infiltrative disease vs. pancreatitis/pancreatic abscess vs. benign cysts
Comments
Note please try to stay to
Note please try to stay to quick bullet format on the history.
These are pancreatic cysts and usually not neoplastic… occasionally occur with carcinoma but more often occur with chronic active pancreatitis and often become infected. I would drain and culture and tx for pancreatitis and fna any parenchyma you can and/or cytospin the drained fluid and make slides of the spun down sediment for analysis… its give the benefit of the doubt to the cat on these presentations until something on a slide says carcinoma.
Here’s a similar case from the basic search
http://sonopath.com/members/case-studies/cases/pancreatic-cystic-degeneration-15-year-old-fs-cat
The liver mass is concerning though as dsignificant disruption of architecture is seen suspect carcinoma needs an fna.
Thank you, Eric. Sorry for
Thank you, Eric. Sorry for the longer hx – was a cut and paste job! Have you experienced complications during drainage when major vessels are nearby? Do they frequently recur in the benign situation?
just push the body wall down
just push the body wall down to the cyst and the vessels displace… it becomes a glorified cystocentesis. Recurrence is variable but they usually respond clinically to drainage of cysts this big… i think they are uncomfortable just from space occupying and worse if infected.