- 8 year old MN Boxer with 3 month history of diarrhea, most recently liquid, and 15 lb weight loss
- Nonresponsive to metronidazole and deworming.
- BCS=2/9
- Chem prof shows ALB=1.6
- Bile acid testing is wnl. UPUC ratio was normal.
- Abdominal ultrasound showed a scant amount of mucosal stipling
- Corn oil test (12mls corn oil, high fat diet, followed 40mn later by repeat scan) showed faint mucosal fogging but no mucosal striations.
- 8 year old MN Boxer with 3 month history of diarrhea, most recently liquid, and 15 lb weight loss
- Nonresponsive to metronidazole and deworming.
- BCS=2/9
- Chem prof shows ALB=1.6
- Bile acid testing is wnl. UPUC ratio was normal.
- Abdominal ultrasound showed a scant amount of mucosal stipling
- Corn oil test (12mls corn oil, high fat diet, followed 40mn later by repeat scan) showed faint mucosal fogging but no mucosal striations.
- I am suspicious for PLE but am not impressed by the images I see. What do you guys think?
- The first 2 images are pre corn oil test and the last image and video are 40 mn post corn oil.
Comments
Just tagging along on this
Just tagging along on this discussion. Have not heard of the corn oil trick before. How reliable is it in highlighting the changes seen w/ lymphangetasia and does it produce any false negatives?
Sam
UC Davis did the work on the
UC Davis did the work on the corn oil trick in yorkies mainly the researcher internist name escapes me. It really isnt needed here because with albumin 1.6 and no proteinuria and liver is fine there is only one place its coming from and no neoplastic crietria in the GI and there are some mucosal striation i your second image (see attached image). Mucosal striations can be variable and highly depoendienbt on resolution gain and other settings and sometimes are more “mucosal fogging” as I call it as opposed to striations where there is just a fogging of the mucosae anwhere striations just blend in an cloud up. So I would Tx PLE and ensure no complicating issues like GI fungal or parasites. Here’s my quick protocol and the curbside guide has a nice chapter on this as well:
https://sonopath.com/products/book
You can vary this as not all is needed depending on the case needs:
PLE Therapy
OBJECTIVE: keep albumin levels > 2 g/dl, Avoid thromboembolism and cavitary effusions, monitor concurrent PLN (Wheaton Terrier PLE/PLN) and liver disease:
Plasma 10 mL / kilogram IV over 4 hours
Or Human albumin 2 ml/kg/h over 10 hours. Total daily volume 20.l/kg/day
And Colloids/Hetastarch
10 to 20 mL per kilogram per hour and dogs
10 to 15 mL per kilogram per hour cats
(Can bolus first 1/3 of dose over 15 minutes)
& maintain on LRS maintenance otherwise.
Metronidazole (10-20 mg/kg po bid)
Famoditine 1 mg/kg Iv Im po dc Sid /bid
Sucralfate 0.5-1 g po tid dogs, 0.5 g bid cats in slurry Or Misoprostol 1-5 ug/kg po tid
Diet: Highly digestible high quality protein, low fiber, low fat diet (< 15% of dry matter). Hydrolyzed protein or novel protein. Purina HA or Royal Canine HP or similar.
Prednisone or prednisolone 2 mg/kg bid x 3-5 days then 2 mg/kg sid. Chlorambucil in refractive severe IBD/alimentary lymphoma cases (monitor cbc for rare bone marrow suppression) 4 mg/m2 Q 24-48 hours.
Cobalamine (B12) 250-1500 ug/dog weekly x 6 weeks.
Calcium supplementation if necessary.
Aspirin 0.5-1 mg/kg/day or Clopidrel (Plavix) 1-5 mg/kg/day.
Here are some other PLE cases from the sonopath archive using search words mucosal striation:
http://sonopath.com/members/case-studies/search?text=Mucosal+striations&species=All
Ok, I was calling that
Ok, I was calling that fogging. I could see mucosal striations much more distinctly on my previous machine (Logiqe). Thanks Eric!
Thsi is a good example of
Thsi is a good example of fogging as the striations coalesce together.
http://sonopath.com/members/case-studies/cases/lymphangectasia-presentation-likely-protein-losing-enteropathy-ple-4-year
Ok,thx!
Ok,thx!