A 15-year-old SF Canine mix was presented for evaluation of suspected septic shock. On physical examination, the patient was in lateral recumbency, had a painful abdomen, the liver was rounded and enlarged, and pyrexia was present. Abnormalities on serum biochemistry were azotemia, hyperphosphatemia, severely elevated ALT activity, and hypoglycemia.
Enlarged irregular spleen. Focal splenic mass, abscess or possible infarct.
Mild uniform enlargement of the left adrenal gland and focal enlargement of the caudal pole of the right adrenal gland.
Treatment for sepsis is recommended. Plasma transfusion and plasma expanders would be ideal in this patient as well as aggressive intravenous antibiotics and glucose supplementation. 25-gauge ultrasound-guided FNA of the splenic mass, general spleen and 22-gauge FNA of the liver would be recommended for further definition. There is a potential for neoplasia in this patient. However, abscessation and aggressive infectious disease is also possible. Guarded prognosis depending upon cytology and response to therapy. Enrofloxacin and Metronidazole combination would be recommended.
Serial blood pressure measurements are recommended. The right adrenal gland should be monitored as there is a potential for pheochromocytoma. If the sonographer is comfortable with the procedure FNA is possible, though it may be a difficult aspirate. However, 25-gague or 27-gauge FNA of the caudal pole of the right adrenal gland would be ideal. There is a potential link between the right adrenal gland and splenic lesion.
The spleen revealed a hypoechoic mass that measured 2.0 cm with pericapsular inflammatory pattern. The remainder of the spleen presented scalloping contour. Trace free fluid was noted adjacent to the spleen.
The right adrenal gland was enlarged, hypoechoic and mildly irregular measuring 2.88 x 1.3 cm at the caudal pole and 0.97 cm at the cranial pole. The left adrenal gland was slightly swollen and measured 2.87 x 0.8 cm at the caudal pole and 0.56 cm at the cranial pole.
None
No video of the left adrenal was available.
Peritonitis – septic (intestinal perforation, ruptured gall bladder, ruptured abscess), urine, bile
Neoplasia
Acute hepatitis – viral, bacterial, toxins
Acute pancreatitis
None
