Sonopath Forum

Rule out gastric mass in 10 year old MN lab

2 weeks of inappetence in a 10 year old mn lab ret that normally eats well
Normal labs except for chronic mild elevations in liver enzymes
Radiographs show a distended pylorus, possible mass
Abdominal US after 12 hour fast shows retained fluid in gastric fundus. Initially thought I was seeing ingesta and chyme in the pylorus but am now suspecting a wall mass
Owner is leaving town in less than 48 hours and is considering euthanasia.

2 weeks of inappetence in a 10 year old mn lab ret that normally eats well
Normal labs except for chronic mild elevations in liver enzymes
Radiographs show a distended pylorus, possible mass
Abdominal US after 12 hour fast shows retained fluid in gastric fundus. Initially thought I was seeing ingesta and chyme in the pylorus but am now suspecting a wall mass
Owner is leaving town in less than 48 hours and is considering euthanasia.
What do you think about the fundus and pyloric outflow? Could not get good CF Doppler due to excessive abdominal wall movement (panting).

Comments

Pankatz

December 21, 2019 at 12:21 pm -

Looks like an intraluminal

Looks like an intraluminal mass to me Melissa. Gastric polyp? Could that be a blood vessel feeding it at 1 o’clock in the last video? In these cases where I am having a tough time deciding, I have sedated, intubated and tubed in a bit of fluid to help distend the stomach a bit to define the lesion better. Would be great to scope.

Electrocute

December 21, 2019 at 2:13 pm -

Thanks Jacquie. Appreciate

Thanks Jacquie. Appreciate your input.

DrMac

December 22, 2019 at 3:14 pm -

There is focal to mild

There is focal to mild regional mural thickening right at the gastroduodenal junction and maybe somewhat extending into the very upper duodenum. I see intact wall layering in the pylorus wall around the lesion but loss of distinct wall layering in the lesion itself. Certainly a concern for neoplasia given the age of the patient but could also be benign inflammation or other . Helicobacter may be a less likely possibility. I dont see obvious ulceration.

Further evaluation with biopsy would be ideal with endoscopy. I would suggest empirical therapy for gastritis / Helicobacter with canned LA or hydrolyzed diet and Omeprazole +/- Sucralfate and reassess in 2-3 weeks depending on clinical response.