11 yo MN Golden with acute kidney failure, hx of CKD for 2 years.
Anorexia, ptyalism, regurgitating liquid.
Severe non regenerative anemia (HCT 15, Hgb 5.8<13) today, HCT was 31 last week.
Azotemia improved with IV fluids last week, but came back once patient was home.
Lepto PCR negative.
1) dilated stomach with diffusely thickened wall (1cm), anechoic fluid and hyperechoic thin linear material (grass?). Uremic gastropathy?
2) Thickened pylorus, mass effect or just thickening?
11 yo MN Golden with acute kidney failure, hx of CKD for 2 years.
Anorexia, ptyalism, regurgitating liquid.
Severe non regenerative anemia (HCT 15, Hgb 5.8<13) today, HCT was 31 last week.
Azotemia improved with IV fluids last week, but came back once patient was home.
Lepto PCR negative.
1) dilated stomach with diffusely thickened wall (1cm), anechoic fluid and hyperechoic thin linear material (grass?). Uremic gastropathy?
2) Thickened pylorus, mass effect or just thickening?
Normal intestines, spleen, liver, GB, pancreas, kidneys, etc… No swollen LN, no pericardial effusion.
Thank you!
Julie
Comments
Obstructive pyloric mass lsa
Obstructive pyloric mass lsa vs carcinoma… pythiosis maybe if in such a region. Good move on the doppler to see the vascularization. Fna should prove dx. Let us know what the cyto is if they let you get it. Second to last video is a good angle to sample just push the body wall down further to the mass under sedation.
Wow, thank you so much. The
Wow, thank you so much. The pylorus is my nemesis… (used to be adrenals and pancreas!).
This will really help the owners make a final decision and not feel bad about it. Thank you.
I don’t think they will call me back for an FNA, but if so, I’d have to go intercostal. I have never done intercostal FNA, even for liver. Any advice or things I should know?
Julie
SDEP 13 has pylorus every
SDEP 13 has pylorus every time as does SDEP 11 if now obstructive ingesta but 13 there every time no matter whats in the stomach. Practice SDEP 13 its pylorus and pv/cbd sliding to the spine. Im thinking with sedation right lateral recumbency as usual over the top SDEP 9 left lower intercostal should put you right on this mass. Have a tech place both hands on the chest pushing down to minimize the distance lined up between the ribs. At that point its a glorified cysto onto this pyloric mass:) I take all my liver samples intercostal lower 1/3 of chest as there is nothing but body wall and liver. Our sdep abdomen unleashed i go through sampling approaches as well as all the sdep and shunt hunt and crypt orchid approach. Check it out
https://www.shopsonopath.com/online-ultrasound-courses
Thank you for all the tips. I
Thank you for all the tips. I have watched the video of your liver fna intercostal. Still scares me a little! I’ll just have to try it.
Planning on getting the SDEP unleashed when I can.
Hey Julie
Fwiw… I was
Hey Julie
Fwiw… I was nervous about intercostal FNAs. But now I find them easier. The liver seems to “move around” less with a little pressure on the ribcage, holds it nicely. You’re right….. just gotta try it. 
– Karen
Thanks Karen! I just have to
Thanks Karen! I just have to do it
Update: patient did “ok” for
Update: patient did “ok” for a month with supportive care. He passed away suddenly at home yesterday.
Thx for the followup. Sudden
Thx for the followup. Sudden death in this scenairo i would bet gastric perforation likely. Bad disease.
I was wondering about the
I was wondering about the cause of death. He passed away fast and mom said tons of liquid came out of his mouth. Sad. But apparently he was “happy” for a few weeks with supportive care, so the owners were thankful for that.