– 3 year old male bulldog
– recent history of weight loss, weakness
– always tended to vomit food if not watered down according to the owner (nothing new)
– bloodwork showed elevated bilirubin
– scanning through the pylorus, the wall appers thickened and hyperechoic and hard to differentiate layering in some areas
– the fundus looks normal to me and the duodenum and rest of SI tract looked normal
– a single enlarged gastric LN was detected; liver and spleen looked normal on ultrasound
– 3 year old male bulldog
– recent history of weight loss, weakness
– always tended to vomit food if not watered down according to the owner (nothing new)
– bloodwork showed elevated bilirubin
– scanning through the pylorus, the wall appers thickened and hyperechoic and hard to differentiate layering in some areas
– the fundus looks normal to me and the duodenum and rest of SI tract looked normal
– a single enlarged gastric LN was detected; liver and spleen looked normal on ultrasound
Could this be pyloric hypertrophy? Infiltrative disease? Normal? (the pylorus is my nemesis!)
I have recommended biopsy of the liver (simply because of the elevated bilirubin) and biopsy of the gastric LN – possible scope and stomach biopsy?
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Comments
With the thickening and loss
With the thickening and loss of layering of the pylorus as well as the enlarged lymph node I would be worried about infiltrative disease rather than hypertrophy. The weight loss and weakness would be more indicative of systemic disease than pyloric hypertrophy. Biopsy of the pylorus and lymph node is warrented.
With the thickening and loss
With the thickening and loss of layering of the pylorus as well as the enlarged lymph node I would be worried about infiltrative disease rather than hypertrophy. The weight loss and weakness would be more indicative of systemic disease than pyloric hypertrophy. Biopsy of the pylorus and lymph node is warrented.
I agree with remo but 3
I agree with remo but 3 things make me think non neoplastic. The LN is longer than it is wide and MM Larson did some work on this and I don’t remember the numbers but longer than wide was more consistent with reactive but distortion and wider than long was more consistent with neoplasia (lsa usually). The age and a happy spitter history in this breed often I have seen primary and secondary hypertrophy and helicobacter may play a role. Last there is a bit of detail loss but I can still see the lines/submucosa of the wall even though a bit lumped up. Play US video game and get an fna of that LN under sedation, corkscrew technique and then pcr or parr if need be at CSU or NC state on cytology if lymphoid this & that comes up and they wont call lsa. When looking ahead to need for PCR I just send the slides directly for read in those CSU or NC state departments in case PCR or PARR is necessary instead of trying to chase down slides after i get th efence dwelling read. Carcinoma also a potential but lower on the list with this age. I wouldnt scope here as the mucosa is not involved enough and results will likely be nebulous. Carte Blanche is surgical full thickness and Ln bx but I like to put needles in things so fna of the LN is where I would start.
Re the pylorus go right intercostal IC 11-13 the pylorus is always there for you except in gdv and hernia no matter what the stomach has in it.
Attached are examples of gastric carcinoma (Lilly) and mild detail loss in surgically confirmed gastritis with hypertrophy and helicobacter (Daphne)…. see helicobacter gastritis can have some detail loss. (Images Andi Parkinson rdms in Baltimore)
re empirical tx for Helicobacter (Remo may have a better mousetrap but I still use the willard protocol form years ago) try hypoallergenic diet canned bid (dry will just sit there and churn in this guy), amoxy or zithromax + metronidazole pepcid carafate x 4 weeks and rescan and post it again and lets see what we have.
great images!
I agree with remo but 3
I agree with remo but 3 things make me think non neoplastic. The LN is longer than it is wide and MM Larson did some work on this and I don’t remember the numbers but longer than wide was more consistent with reactive but distortion and wider than long was more consistent with neoplasia (lsa usually). The age and a happy spitter history in this breed often I have seen primary and secondary hypertrophy and helicobacter may play a role. Last there is a bit of detail loss but I can still see the lines/submucosa of the wall even though a bit lumped up. Play US video game and get an fna of that LN under sedation, corkscrew technique and then pcr or parr if need be at CSU or NC state on cytology if lymphoid this & that comes up and they wont call lsa. When looking ahead to need for PCR I just send the slides directly for read in those CSU or NC state departments in case PCR or PARR is necessary instead of trying to chase down slides after i get th efence dwelling read. Carcinoma also a potential but lower on the list with this age. I wouldnt scope here as the mucosa is not involved enough and results will likely be nebulous. Carte Blanche is surgical full thickness and Ln bx but I like to put needles in things so fna of the LN is where I would start.
Re the pylorus go right intercostal IC 11-13 the pylorus is always there for you except in gdv and hernia no matter what the stomach has in it.
Attached are examples of gastric carcinoma (Lilly) and mild detail loss in surgically confirmed gastritis with hypertrophy and helicobacter (Daphne)…. see helicobacter gastritis can have some detail loss. (Images Andi Parkinson rdms in Baltimore)
re empirical tx for Helicobacter (Remo may have a better mousetrap but I still use the willard protocol form years ago) try hypoallergenic diet canned bid (dry will just sit there and churn in this guy), amoxy or zithromax + metronidazole pepcid carafate x 4 weeks and rescan and post it again and lets see what we have.
great images!
Thanks Remo and Eric – would
Thanks Remo and Eric – would love to FNA this one but the owner may have our hands tied for this so some medical therapy may be the only option and seeing what happens.
Eric, I think you are referring to the SA/LA ratio for LN’s where <0.5 was least likely to be associated with neoplasia. This case is 0.6 so borderline, but of course biospy is the gold standard.
Thanks Remo and Eric – would
Thanks Remo and Eric – would love to FNA this one but the owner may have our hands tied for this so some medical therapy may be the only option and seeing what happens.
Eric, I think you are referring to the SA/LA ratio for LN’s where <0.5 was least likely to be associated with neoplasia. This case is 0.6 so borderline, but of course biospy is the gold standard.
yes correct on the ratio
yes correct on the ratio thank you… dust in the cerebellum:)
yes correct on the ratio
yes correct on the ratio thank you… dust in the cerebellum:)
Well shotgun tx and
Well shotgun tx and rescan…. the $ pet owners and fear of needle owners like this approach with appropriate disclaimers of course
Well shotgun tx and
Well shotgun tx and rescan…. the $ pet owners and fear of needle owners like this approach with appropriate disclaimers of course