Hello,
This is a 13 years old daschund that has very high liver enzymes : marked ALP elevation, extreme GGT elevation and moderate ALT . Dog is not clinical.
AUS : mixed echoic mass that measures 4.5 cm in diameter situated at the cranial and left aspect of the liver . We suspect Benign Adenoma vs Adenocarcinoma . Also nodule on left Adrenal- possible cyshings
Unfortunatelly FNA did not get us any closer to the dg.
Hello,
This is a 13 years old daschund that has very high liver enzymes : marked ALP elevation, extreme GGT elevation and moderate ALT . Dog is not clinical.
AUS : mixed echoic mass that measures 4.5 cm in diameter situated at the cranial and left aspect of the liver . We suspect Benign Adenoma vs Adenocarcinoma . Also nodule on left Adrenal- possible cyshings
Unfortunatelly FNA did not get us any closer to the dg.
Would you recommend US guided core biopsy? It seems to me that many specialists including radiologists are chosing sx wedge biopsies over U/S guided Core biopsies. Is that true in your neck of the woods, as well ? Although not always diagnostic, it seems a lot easier / less invasive to do true cut. I also suspect it does require skill to get a good dg biopsy.
Thank you
Comments
Wedge bx on scope only works
Wedge bx on scope only works on lesions that you can see on the capsule from the scope so this would likely be ok here if htey get up around the falciform but deep lesions get missed and this pushes on the diaphragm. Core 16 or 18 gauge bx traversing the hypo and hyperechoic changes in the mass should be solid dx here just obviously avoiding vessels and any areas of cavitation… on core bx keep the trajectory cutting into the normal to abnormal transition and stay parenchymal. CT for possible sx planning as it may be resectable.
Lower left intercostal SDEP position 10 would be my approach here.
Thank you EL
Thank you EL