Case Study

Pancreatitis and pancreatic cyst diagnosed by ultrasound-guided FNA in a 7 year old MN Border Collie

A 7-year-old neutered male Border Collie mixed breed dog presented after a long history of occasional vomiting and elevated lipase. The dog had three separate episodes of pancreatitis over the prior two years. The clinical exam at this time was normal, except for minor focal abdominal pain in the right cranial abdomen. The CBC revealed slight leukocytosis with a left shift. Blood chemistry revealed moderately elevated amylase and lipase with a slightly elevated ALP.

A 7-year-old neutered male Border Collie mixed breed dog presented after a long history of occasional vomiting and elevated lipase. The dog had three separate episodes of pancreatitis over the prior two years. The clinical exam at this time was normal, except for minor focal abdominal pain in the right cranial abdomen. The CBC revealed slight leukocytosis with a left shift. Blood chemistry revealed moderately elevated amylase and lipase with a slightly elevated ALP.

DX

Pancreatic inflammation with normal pancreatic cells.

Sonographic Differential Diagnosis

Pancreatitis with acute on chronic changes. Pancreatic cyst or potential abscess. Minor potential for carcinoma or similar neoplasia.

Image Interpretation

The pancreas is visibly enlarged with a largely anechoic cyst at the base of the right limb. The remainder of the pancreas is hypoechoic to surrounding fat, and has a swollen and irregular contour. Pancreatic parenchyma is coarse with mixed hyperechoic changes toward the tail of the right limb.

Outcome

The patient responded well long-term to a strict hypoallergenic diet (duck and potato) and broad spectrum antibiotics over 6 weeks. All blood parameters normalized except for a persistent mildly elevated SAP. The patient was asymptomatic over the following year until he ingested deer feces and garbage and experienced an acute recurrence of clinical signs. The patient recovered again after three days of hospitalization.

Clinical Differential Diagnosis

Chronic active pancreatitis +/- necrosis, IBD, neoplasia, chronic GI obstruction.

Sampling

Ultrasound-guided FNA of the parenchymal portion of the pancreas was conducted, and cytology revealed low-grade pancreatic inflammation with normal pancreatic cells. Fluid analysis of the drained cystic fluid revealed modified transudate with a low grade inflammatory component (video 1 shows drainage procedure).