Case Study

Chronic active pancreatitis and necrosis in a 13 year old FS Springer Spaniel dog

A 13-year-old FS Springer Spaniel that had been vomiting intermittently after a dental and skin mass removal that had been done a few days previously presented for an examination. The only abnormality on physical examination was a slight pot bellied appearance. Urinalysis showed an inappropriate specific gravity (1.018), bilirubinurea, proteinurea, and bacteriuria. CBC and serum biochemistry showed thrombocytosis, elevated ALP, elevated GGT, and elevated ALT activity, elevated cholesterol and elevated triglycerides. T4 was normal.

DX

Pancreatits: fat necrosis with hemorrhage and chronic active inflammation

Sonographic Differential Diagnosis

Focal pancreatitis localized to the right limb, potential for carcinoma. FNA would be warranted. Potential for resection. The chronic ALT and ALKP elevations in this patient is likely owing to reactive hepatopathy deriving from low grade pancreatic inflammation. However, FNA of the liver lesions are strongly recommended in this case and primary treatment for pancreatitis would be warranted. Broad spectrum antibiotics and dietary change would be warranted.

Image Interpretation

The region of the pancreas, primarily in the right limb revealed a hypoechoic 2.04 x 1.3 cm lesion with perilesional, hyperechoic fatty inflammation. This is most consistent with focal pancreatitis. There is a minor potential for carcinoma. FNA would be warranted. The remainder of the pancreas appeared largely unremarkable with minor remodeling.

Outcome

None

Clinical Differential Diagnosis

G.I. clinical signs- ulcer, neoplasia, IBD, reflux esophagitis. Pancreas clinical signs- pancreatitis, neoplasia.
Liver clinical signs- vacuolar hepatopathy, neoplasia, chronic liver disease, cirrhosis, infection (bacterial/fungal), drug reaction.

Sampling

Liver aspirates revealed moderate to marked vacuolar hepatopathy. Increased fibrovascular stroma. Pancreatic cytology revealed fat necrosis with hemorrhage and chronic active inflammation.