Case Study

Adrenal mass with CVC invasion in a dog

A dog of unknown breed, gender and age, was presented for evaluation of polyuria, polydypsia, and abdominal guarding. No abnormalities were present on bloodwork.

A dog of unknown breed, gender and age, was presented for evaluation of polyuria, polydypsia, and abdominal guarding. No abnormalities were present on bloodwork.

Sonographic Differential Diagnosis

Invasive and slightly mineralized right adrenal gland mass. Given the patient’s history of PU/PD, this is suggestive for adenocarcinoma, although there is a possibility of pheochromocytoma with secondary PU/PD.

Image Interpretation

The left adrenal gland was uniform in size and contour. It measured 0.41 cm. There was a mass with loss of structural detail in the region of the right adrenal gland. The mass, which contained focal areas of mineralization, appeared to be deriving from the cranial pole of the right adrenal, invading the phrenic vein, and continuing into the vena cava. The invasion continued 3-4 cm cranially in the vena cava. No obvious metastatic lesions were noted.

Outcome

The owner declined surgery for the adrenal tumor, however shortly thereafter the dog got into a fight with another dog and died.

Comments

If the owner had elected further workup, blood pressure measurements would be warranted as well as ACTH stimulation. If the patient is clinically Cushingoid based on ACTH stimulation results, then Lysodren therapy could be considered as a palliative measure. Urine culture and sensitivity via cystocentesis would be ideal. Aspirin therapy should be considered given that often much of the echogenic structure within the lumen of the vena cava may be attached thrombus.