These images are from a 1.5 year old intact male Boxer. He has been vomiting for months now and lost a dramatic amount of weight. This is the first time we have seen him.
I don’t see major lesions in the GI tract. Layers appear normal, size is normal, and there are no dilated areas.
I am really struggling with the interpretation of what I do see.
-He has many visible normal abdominal lymph nodes. There are several enlarged, mixed echogneitiy lymph nodes between the liver and stomach. The still and one of the clips shows this.
These images are from a 1.5 year old intact male Boxer. He has been vomiting for months now and lost a dramatic amount of weight. This is the first time we have seen him.
I don’t see major lesions in the GI tract. Layers appear normal, size is normal, and there are no dilated areas.
I am really struggling with the interpretation of what I do see.
-He has many visible normal abdominal lymph nodes. There are several enlarged, mixed echogneitiy lymph nodes between the liver and stomach. The still and one of the clips shows this.
-There is a large area of abnormally hyperechoic tissue that extends caudal to the spleen along the left abdominal wall. Ignore the label that says liver t.v; it is a saggital scan along the left body wall caudal to the spleen, which is visible toward the end of the clip.
-There is one very hyperechoic presumed lymph node just medial to the above mentioned hyperechoic tissue. Not pictured but I could if it’s important.
-One of the clips shows several normal-appearing loops of bowel with associated mesenteric lymph nodes then a mixed echogenicity band of tissue with a good blood supply extending caudally. This tissue extended caudally almost to the apex of the bladder, cranially to just caudal to the stomach, then over to the right side. What is it?
-The final clip shows the intersection of 2 bowel loops, is this the ileocecocolic junction? I don’t usually look for it in dogs.
My impression is that I’m likely dealing with a neoplastic or granulomatous process. I got several FNA’s from different locations of the mixed echogenicity tissue but mostly just saw peripheral blood cells.
I’d appreciate any advice you can get from the images.
Thanks!
Suzanne
Comments
The last loop is the icj and
The last loop is the icj and the submucosal layer of the ileum looks thick suggestive of chronicity. The LN is enlarged but echogenic and still egg shaped so likely reactive but fna to be sure. Parasitism, fungal, chronic ibd, neoplasia possible but less likely. The minor free fluid happens in the ijc region from lymphatic congestion you will see it in lsa cases a lot but also in chronic lymphadenitis like I am suspecting here.
The last loop is the icj and
The last loop is the icj and the submucosal layer of the ileum looks thick suggestive of chronicity. The LN is enlarged but echogenic and still egg shaped so likely reactive but fna to be sure. Parasitism, fungal, chronic ibd, neoplasia possible but less likely. The minor free fluid happens in the ijc region from lymphatic congestion you will see it in lsa cases a lot but also in chronic lymphadenitis like I am suspecting here.
So is the tissue in the
So is the tissue in the second clip just reactive mesentery?
What about clip #3? I see the normal-appearing lymph nodes surrounding the vessels but the structure that is larger and has a good blood supply is what is confusing me. Is it also enlarged lymphatic tissue?
I took FNAs from multiple locations but don’t believe they’re diagnostic. I’m hoping the owner will allow an ex. lap.
Thanks again,
Suzanne
So is the tissue in the
So is the tissue in the second clip just reactive mesentery?
What about clip #3? I see the normal-appearing lymph nodes surrounding the vessels but the structure that is larger and has a good blood supply is what is confusing me. Is it also enlarged lymphatic tissue?
I took FNAs from multiple locations but don’t believe they’re diagnostic. I’m hoping the owner will allow an ex. lap.
Thanks again,
Suzanne
I’m guessing its the
I’m guessing its the mesenteric artery or vein as it gets tortuous when the adjacent structures enlarge and cause congestion there…. lymphatic (hence the local free fluid), venous and arterial.
I promise I am not trying to
I promise I am not trying to beat a dead horse here but I just want to make sure I understand so I’ll get it next time I see this presentation. I know Eric is very busy so I am happy to get others’ opinions as well.
Clip #2 shows a tubular structure that is very hyperechoic running caudal to the spleen along the body wall…I am guessing this is just reactive mesentery that has a very organized appearance. Is that probably right?
Clip #3, which shows the small amount free fluid and tortuous vessels also shows a mixed echogenicity tubular structure that first appears toward the right side of the screen in cross section then is shown in longitudinal. It is much larger than the small lymph nodes that are visible in the clip. Is this likely lymphatic tissue? If not what is it? Is it common to have dramatic enlargement in close proximity to normal-appearing nodes? This is where I got my FNAs from. I did not find a good window on the obvious affected lymph node without having to go through the liver to get there.
Thanks again,
Suzanne
I’m guessing its the
I’m guessing its the mesenteric artery or vein as it gets tortuous when the adjacent structures enlarge and cause congestion there…. lymphatic (hence the local free fluid), venous and arterial.
I promise I am not trying to
I promise I am not trying to beat a dead horse here but I just want to make sure I understand so I’ll get it next time I see this presentation. I know Eric is very busy so I am happy to get others’ opinions as well.
Clip #2 shows a tubular structure that is very hyperechoic running caudal to the spleen along the body wall…I am guessing this is just reactive mesentery that has a very organized appearance. Is that probably right?
Clip #3, which shows the small amount free fluid and tortuous vessels also shows a mixed echogenicity tubular structure that first appears toward the right side of the screen in cross section then is shown in longitudinal. It is much larger than the small lymph nodes that are visible in the clip. Is this likely lymphatic tissue? If not what is it? Is it common to have dramatic enlargement in close proximity to normal-appearing nodes? This is where I got my FNAs from. I did not find a good window on the obvious affected lymph node without having to go through the liver to get there.
Thanks again,
Suzanne
Video 1 Im seeing Ln
Video 1 Im seeing Ln adjacent to mesenteric vessels.
Video 2 Im not sure I would need some more depth for perspective here… It kinda looks like pancreas but not sure. Do you have another view at about 6-8 cm field depth?
Video 3 I am seeing small intestine mesenteric vessels and enlarged chronic lympadenitis type LN.
Video 4 I am seeing ileocecal wiht increased submucosal echogenicity and thickness suggestive fror chronic inflammation.
Thanks – very helpful! I
Thanks – very helpful! I wondered if clip 2 might be the left limb of the pancreas but I’m not sure I have better clips. I appreciate the help!
Suzanne
Video 1 Im seeing Ln
Video 1 Im seeing Ln adjacent to mesenteric vessels.
Video 2 Im not sure I would need some more depth for perspective here… It kinda looks like pancreas but not sure. Do you have another view at about 6-8 cm field depth?
Video 3 I am seeing small intestine mesenteric vessels and enlarged chronic lympadenitis type LN.
Video 4 I am seeing ileocecal wiht increased submucosal echogenicity and thickness suggestive fror chronic inflammation.
Thanks – very helpful! I
Thanks – very helpful! I wondered if clip 2 might be the left limb of the pancreas but I’m not sure I have better clips. I appreciate the help!
Suzanne
You bet our pleasure
You bet our pleasure interesting case
You bet our pleasure
You bet our pleasure interesting case
I just wanted to post the
I just wanted to post the ending to this case. The FNA’s were inconclusive so we went to surgery for biopsies. The mesenteric lymph nodes were huge and the pancreas appeared mildly inflamed. Grossly, the intestines appeared hypoxic and hypomotile. The dog continued downhill after the surgery and died several days ago.
The biopsy results showed pythium in the lymph nodes (which were completely replaced by fungus and fibrous tissue), mild pancreatitis and mild lymphoplasmacytic changes in the intestines.
Thanks for the help!
Suzanne
I just wanted to post the
I just wanted to post the ending to this case. The FNA’s were inconclusive so we went to surgery for biopsies. The mesenteric lymph nodes were huge and the pancreas appeared mildly inflamed. Grossly, the intestines appeared hypoxic and hypomotile. The dog continued downhill after the surgery and died several days ago.
The biopsy results showed pythium in the lymph nodes (which were completely replaced by fungus and fibrous tissue), mild pancreatitis and mild lymphoplasmacytic changes in the intestines.
Thanks for the help!
Suzanne
wow pythiosis.. fits with
wow pythiosis.. fits with granulomatous LN. Where are you located?? texas?
Central Texas. I have seen
Central Texas. I have seen several pythium cases in my career but this is the first that only seemed to involve the mesenteric nodes.
Thanks again,
Suzanne
wow pythiosis.. fits with
wow pythiosis.. fits with granulomatous LN. Where are you located?? texas?
Central Texas. I have seen
Central Texas. I have seen several pythium cases in my career but this is the first that only seemed to involve the mesenteric nodes.
Thanks again,
Suzanne
cool case … case of the
cool case … case of the month if you wish to send me everything… go to spa (consultation upload) on the bottom of the home page. Need info from presentation to outcome and how you want ot be credited. Cool case bad disease.
cool case … case of the
cool case … case of the month if you wish to send me everything… go to spa (consultation upload) on the bottom of the home page. Need info from presentation to outcome and how you want ot be credited. Cool case bad disease.