Sonopath Forum

Severe anemia in a dog with an intestinal mass

8 year old MN Blue Heeler X who initially presented 5 weeks ago for lethargy and decreased appetite
Bloodwork initially showed a PCV of 26.8%. It is now 15.2%. Other labwork abnormalities include a reticulocytosis of 5.9%, leukoctyolsis of 21.52K/mcl (neutropphilia and monocytosis). Chem prof done 6 weeks ago showed a decreased BUN=6mg/dl.
The dog was placed on pred and doxycycline.

8 year old MN Blue Heeler X who initially presented 5 weeks ago for lethargy and decreased appetite
Bloodwork initially showed a PCV of 26.8%. It is now 15.2%. Other labwork abnormalities include a reticulocytosis of 5.9%, leukoctyolsis of 21.52K/mcl (neutropphilia and monocytosis). Chem prof done 6 weeks ago showed a decreased BUN=6mg/dl.
The dog was placed on pred and doxycycline.
Abdominal rads read by a boarded radiologist showed hepatomegaly and possible sublumbar lymphadenopathy. An abdominal US was recommended.
Abdominal US shows an asymmetical, circumferential small intestinal mass in the left midabdomen. Part of the wall mass contains an psuedocyst or cavitation. Hepatomegaly, hypovolemic spleen, and one reactive mesenteric lymph node were present.
My differential diagnoses list includes LSA, leimyosarcoma, carcinoma, and less likely benign leiomyoma or foreign body granuloma (no FB seen).
I am wondering about the cystic portion of the mass-could this be hemorrhage from a foreing body? I just don’t see anything strongly shadowing. There is no obstructive pattern and no history of vomiting or diarrhea.
Any other thoughts?

Comments

rlobetti

November 9, 2016 at 2:35 pm -

Looks like an infiltrative

Looks like an infiltrative intestinal mass and not like a foreign body obstruction or granuloma. Fluid could be blood or even chyle (if there is some lymphatic obstruction). An aspirate would give you more information.

Electrocute

November 9, 2016 at 9:40 pm -

Thanks Remo. I wanted to do

Thanks Remo. I wanted to do aspirtes, but because the dog had a PCV of 15% and no coag panel, I opted not to do it at the time of the initial exam.

November 9, 2016 at 10:56 pm -

Looks like round cell tumor

Looks like round cell tumor to me. These typically do not bleed. 25g in th ehypoechoic area should be diagnostic. Transfuse first ideally.

Electrocute

November 10, 2016 at 2:00 pm -

Thanks Eric. The dog had

Thanks Eric. The dog had dropped recently from 25% to 15% so that also made me hesitant to aspirate. Interestingly, he had already been placed on pred and Doxy with no response. Not sure how big an immediate impact pred alone would have on that mass even if it is LSA. See you tomorrow :).