Sonopath Forum

Pancreatitis vs neoplasia

Hello

This is Zac a 7 year old Portuguese. Presented for sudden lethargy and vomiting. Abdominal xrays showed increased radiopacity caudal to the stomach and US revealed a markedly abnormal pancreas. There are 2 hyperechoic nodules on the left limp inside a capsule of fluid and I am suspicious for neoplasia. FNAs have been performed. Minimal to no neutrophils so I do not believe abcess is possible and the hyperechoic nodules were sampled via US. While we are waiting for the cytology report I thought I would ask opinions on whether this has the appearence of neoplasia or not. We initially thought addison’s but with the findings the clients have temporarily declined BW until cytology returns.

Thanks. Brent

Comments

tosullivan

February 9, 2017 at 10:23 pm -

The strangest thing happened

The strangest thing happened when I tried to view the 1st image. It was an image of something else. I refreshed and it’s OK now. Please let me know if there is an image of something other than the pancreas. I have been having some computer gremlins. Brent

February 9, 2017 at 10:33 pm -

This looks like a

This looks like a pancreatitis pancreatic necrosis case as there are edema lines and saponifiaction of fat but I like to see what the duct is doing as neoplasia destroys architecture like ducts and this duct is congested and a little tortuous but is holding its position. There isn’t a mass effect against it. That being said carcinoma and pancreatitis can live together and always needs a needle in my opinion but Im leaning toward pancreatitis/necrosis here. I screen shot your second video and itemized what im seeing to help decifer these things. You can put a needle in each of these areas ideally and see if they correspond to my notations but th ehypoechoic areas are the most important to fna:)

To compare here are some pancreatitis cases on us and CT form the basic search

http://sonopath.com/members/case-studies/search?text=pancreatitis&species=All

and some pancreatic carcinoma and pancreatitis

http://sonopath.com/members/case-studies/search?page=1&text=pancreatic%20carcinoma&species=All

tosullivan

February 9, 2017 at 11:51 pm -

Thanks. We took approximately

Thanks. We took approximately 5-7 samples of the areas. I didn’t know we should concentrate on the hypoechoic areas. We did sample everywhere so hopefully get a positive answer. Will do that next time

I will investigate the prognosis with pancreatic necrosis vs carcinoma. Sac is currently in the hospital but owner will most likely stop treatment with a poor prognosis

Thanks again. Brent