– 12 yr FS Great Pyrenese presented for melena,vomiting and lethargy
– had been on pred for skin issues and owner noted PU/PD and ravenous appetite
– bloodwork mild anemia, ALT 400’s, ALP so high not registering on rDVM’s in house blood machine, mild elevation BUN, amylase and lipase severely elevated, cPLI not done, urinalysis not done
– x-ray showed approx. 10cm diameter radio-opaque mass in the right cranial quadrant cranial to the right kidney and distal to the stomach and the liver
– 12 yr FS Great Pyrenese presented for melena,vomiting and lethargy
– had been on pred for skin issues and owner noted PU/PD and ravenous appetite
– bloodwork mild anemia, ALT 400’s, ALP so high not registering on rDVM’s in house blood machine, mild elevation BUN, amylase and lipase severely elevated, cPLI not done, urinalysis not done
– x-ray showed approx. 10cm diameter radio-opaque mass in the right cranial quadrant cranial to the right kidney and distal to the stomach and the liver
– ultrasound showed a small left adrenal gland (at least I think for a dog this size), hyperechoic liver, and an ill-defined mass like lesion in the right abdomen which was surprisingly quite diffcult to find (considering it being easy to see on x-ray) – was quite dorsal in the patient.
I could see a glimpse of the right adrenal gland but this lesion seemed to be sitting right on top of it or part of it. I also wonder if it may be part of the left pancreatic limb? unfortunately the owner is considering euthanasia for financial reasons but I am curious to figure out what is going on in this patient?
Comments
Looking at this again, I
Looking at this again, I think the large mass on x-ray may not be in the abdomen – possible SQ lipoma?
Looking at this again, I
Looking at this again, I think the large mass on x-ray may not be in the abdomen – possible SQ lipoma?
The mass you are measuring on
The mass you are measuring on the VD x-ray is not visible on the lateral view. I can’t see the dorsal aspect of the dog to see if there is a large lipoma there- but you may be right. I think the R kidney is seen within the mass you are measuring on the VD image. If that is the R kidney it looks small and rounded. Did the R kidney look and measure normal to you?
I am not certain about the adrenal images. On one view it almost appears that you are measuring artifact like a distal enhancement.
I am waiting to see what others say
The mass you are measuring on
The mass you are measuring on the VD x-ray is not visible on the lateral view. I can’t see the dorsal aspect of the dog to see if there is a large lipoma there- but you may be right. I think the R kidney is seen within the mass you are measuring on the VD image. If that is the R kidney it looks small and rounded. Did the R kidney look and measure normal to you?
I am not certain about the adrenal images. On one view it almost appears that you are measuring artifact like a distal enhancement.
I am waiting to see what others say
Im pretty sure its a
Im pretty sure its a right adrenal mass.
Jackie on the VD radiograph I think you overshot RAD measurement of the mass itself I think the lateral view is more appropriate to size should be around 6 cm or so which matches the sonogram. If you look at your last video clip at 5 cm depth it appears that the echogenic mass is deriving from the medial aspect of the right adrenal gland. It is difficult to say if it is invading the vena cava or not and the echogenicity as that of a possible Myelolipoma which is a benign adrenal mass good what you need to do is push harder and approach more dorsally from the right kidney and push that mass and vena cava to approximately 3 cm depth. At that depth the resolution will jump at that point add power Doppler and color flow Doppler and approach it from cranial to caudal the vena cava as a window and do the same thing from the left side. In the basic search just search “adrenal mass” (http://sonopath.com/members/case-studies/search) and you will see many approaches that I’m discussing here and look at the depth that they were taken from. If its invading the cvc then its by default an adenoca or pheochromocytoma. Please post those views if you are able to get them (sedation will help) and of course check a BP and work up true pupd if present.
Im pretty sure its a
Im pretty sure its a right adrenal mass.
Jackie on the VD radiograph I think you overshot RAD measurement of the mass itself I think the lateral view is more appropriate to size should be around 6 cm or so which matches the sonogram. If you look at your last video clip at 5 cm depth it appears that the echogenic mass is deriving from the medial aspect of the right adrenal gland. It is difficult to say if it is invading the vena cava or not and the echogenicity as that of a possible Myelolipoma which is a benign adrenal mass good what you need to do is push harder and approach more dorsally from the right kidney and push that mass and vena cava to approximately 3 cm depth. At that depth the resolution will jump at that point add power Doppler and color flow Doppler and approach it from cranial to caudal the vena cava as a window and do the same thing from the left side. In the basic search just search “adrenal mass” (http://sonopath.com/members/case-studies/search) and you will see many approaches that I’m discussing here and look at the depth that they were taken from. If its invading the cvc then its by default an adenoca or pheochromocytoma. Please post those views if you are able to get them (sedation will help) and of course check a BP and work up true pupd if present.
Hi Randy
Both kidneys were
Hi Randy
Both kidneys were normal on u/s. I believe I am seeing the larger mass on the lateral x-ray view just ventral to the kidney and if you look just cranial to the kidney and caudal to the stomach on lateral x-ray there is what looks like a smaller radio-opaque mass and perhaps this is what I am seeing on ultrasound?
Thanks for educating me. I
Thanks for educating me. I see it now.
Hi Randy
Both kidneys were
Hi Randy
Both kidneys were normal on u/s. I believe I am seeing the larger mass on the lateral x-ray view just ventral to the kidney and if you look just cranial to the kidney and caudal to the stomach on lateral x-ray there is what looks like a smaller radio-opaque mass and perhaps this is what I am seeing on ultrasound?
Thanks for educating me. I
Thanks for educating me. I see it now.
Eric – Colour was not great
Eric – Colour was not great in this one and I think sedation and a lateral approach would the way to go in such a big girl for sure. I’m afraid I won’t get that chance to follow this one up as the owners are not willing to go further.
It was the x-ray that really threw me off on this one!
Eric – Colour was not great
Eric – Colour was not great in this one and I think sedation and a lateral approach would the way to go in such a big girl for sure. I’m afraid I won’t get that chance to follow this one up as the owners are not willing to go further.
It was the x-ray that really threw me off on this one!
Jacquie the color and
Jacquie the color and resolution improves the cloiser you get top the object hence the passive probe hand push… it compresses the titssue makign it more unirform and displaces organs that want to mess wiht your image like the colon and shortens the distance the sound waves have to travel. If you look at the CD trilogy all of my images are < 4 cm even in the big dogs an dif you time it right you only mave to mucle up an couple of seconds to get in there, video clip, and relax.
Plug plug I will be showing this technique ad nauseum in our Puerto Rico seminar in February
both in the 2 days basic/intermediate and th emini lab at the end of the second part-2day lecture.
http://sonopath.com/products
Jacquie the color and
Jacquie the color and resolution improves the cloiser you get top the object hence the passive probe hand push… it compresses the titssue makign it more unirform and displaces organs that want to mess wiht your image like the colon and shortens the distance the sound waves have to travel. If you look at the CD trilogy all of my images are < 4 cm even in the big dogs an dif you time it right you only mave to mucle up an couple of seconds to get in there, video clip, and relax.
Plug plug I will be showing this technique ad nauseum in our Puerto Rico seminar in February
both in the 2 days basic/intermediate and th emini lab at the end of the second part-2day lecture.
http://sonopath.com/products
Puerto Rico very tempting but
Puerto Rico very tempting but I will be in Exuma at that time – maybe I can charter a boat and come on over. It looks like a very practical course for sure.
Puerto Rico very tempting but
Puerto Rico very tempting but I will be in Exuma at that time – maybe I can charter a boat and come on over. It looks like a very practical course for sure.