– 6 year FS Havenese with history of vomitng (mostly at night and in morning) for a few weeks; no diarrhea
– recent bloodwork ALB 16, TP 40, GLOB 24 – other parmaters wnl; fecal negative
– urine SG 1.035, no protein on chemstrip and urine pro:crea ratio pending
– u/s showed an approx. 4cm length of SI with a uniformly hyperechoic mucosal layer with overall normal wall thickness and normal layering; I did not see classic mucosal striations but some mucosal speckling
– 6 year FS Havenese with history of vomitng (mostly at night and in morning) for a few weeks; no diarrhea
– recent bloodwork ALB 16, TP 40, GLOB 24 – other parmaters wnl; fecal negative
– urine SG 1.035, no protein on chemstrip and urine pro:crea ratio pending
– u/s showed an approx. 4cm length of SI with a uniformly hyperechoic mucosal layer with overall normal wall thickness and normal layering; I did not see classic mucosal striations but some mucosal speckling
– at first I thought it was my probe or settings but then I switched presets and also compared other loops of bowel which had a normal hypochoic mucosal layer so I do believe this lesion is real
– rest of scan was normal; no effusion or enlarged LN’s
So looks like a protein losing enteropathy (pending normal pro:crea ratio). What are your thoughts of this bowel lesion? I am scheduled to perform intra-operative ultrasound on this as I think it may be difficult to determine where it is grossly. The plan is to identify the abnormal loop of bowel and biopsy or possibly resect.
Comments
Classic hyperechoic mucosae
Classic hyperechoic mucosae and hyperperistalsis and solidly low albumin and no significant proteinuria and liver ok = PLE. Sometimes the mucosal striations are so abundant the create this mucosal clouding or “fogging”… I should coin this term lol.. But yes PLE.
IOP US awesome!! please post pics post sx but i would give plasma first to prep and plasma expand, coag panel owing to AT3 loss and do an omentopexy after you take the bx… overkill best here as they dont heal well owing to protein loss…and you can feed him a couple tbsp of corn oil with AD or similar 4-6 hours before to enhance the lacteals but not likely needed here.
here are some similar cases: http://sonopath.com/members/case-studies/search?text=mucosal+striations&species=All
Classic hyperechoic mucosae
Classic hyperechoic mucosae and hyperperistalsis and solidly low albumin and no significant proteinuria and liver ok = PLE. Sometimes the mucosal striations are so abundant the create this mucosal clouding or “fogging”… I should coin this term lol.. But yes PLE.
IOP US awesome!! please post pics post sx but i would give plasma first to prep and plasma expand, coag panel owing to AT3 loss and do an omentopexy after you take the bx… overkill best here as they dont heal well owing to protein loss…and you can feed him a couple tbsp of corn oil with AD or similar 4-6 hours before to enhance the lacteals but not likely needed here.
here are some similar cases: http://sonopath.com/members/case-studies/search?text=mucosal+striations&species=All
I recently scanned a 16 year
I recently scanned a 16 year old mn Bichon with a 1 week history of bloody diarrhea, nonresponsive to metronidazole. He also had a hyperechoic small intestinal mucosa, but it was more of a horizontal pattern. His ALB is 3.0, but it had been 3.5. Because of his age, I recommended endoscopy and colonoscopy.
I am just wondering, what is the specificity of hyperechoic intestinal mucosal lesions?
Is there anything else that should be on the rule out list besides PLE, LSA, and lymphangectasia?
I recently scanned a 16 year
I recently scanned a 16 year old mn Bichon with a 1 week history of bloody diarrhea, nonresponsive to metronidazole. He also had a hyperechoic small intestinal mucosa, but it was more of a horizontal pattern. His ALB is 3.0, but it had been 3.5. Because of his age, I recommended endoscopy and colonoscopy.
I am just wondering, what is the specificity of hyperechoic intestinal mucosal lesions?
Is there anything else that should be on the rule out list besides PLE, LSA, and lymphangectasia?
We took this pet to surgery
We took this pet to surgery and found that the SI was diffsuely affected with dilated lacteals which was interesting as many loops of bowel lookeed relatively normal on ultrasound. I performed IOP ultrasound anyway out of interest. Below is gross pic at surgery and I have entered a clip in the original post of what the SI looked like at surgery.
JP
We took this pet to surgery
We took this pet to surgery and found that the SI was diffsuely affected with dilated lacteals which was interesting as many loops of bowel lookeed relatively normal on ultrasound. I performed IOP ultrasound anyway out of interest. Below is gross pic at surgery and I have entered a clip in the original post of what the SI looked like at surgery.
JP
Thx for the followup please
Thx for the followup please post the bx if you can and IOP images.
I have clip added at the
I have clip added at the start of this post (third clip) but here is a still and picture doing it. Will post histo results when they come back.
Thx for the followup please
Thx for the followup please post the bx if you can and IOP images.
I have clip added at the
I have clip added at the start of this post (third clip) but here is a still and picture doing it. Will post histo results when they come back.
Beautiful thank you for
Beautiful thank you for posting.
Beautiful thank you for
Beautiful thank you for posting.
Histopath Results:
These
Histopath Results:
These intestinal biopsies are excellent, and are definitive for primary lymphangiectasia.
The intestine is structurally normal and has no increase in leukocytes, but every villus lacteal is
massively distended to the point of rupture, and the dilation of lymphatics continues within the
submucosa and tunica muscularis. There is absolutely no evidence of neoplasia, and there is no
evidence of previous inflammation or fibrosis that might explain the development of the
lymphangiectasia. The vast majority of cases of lymphangiectasia that I see in dogs are primary
and idiopathic like this.
DIAGNOSIS:
1. IN BIOPSIES OF PERFECT TECHNICAL QUALITY, PERFECT LESIONS FOR SEVERE
PRIMARY LYMPHANGIECTASIA
BRIAN P. WILCOCK, D.V.M., Ph.D., VETERINARY PATHOLOGIST
Histopath Results:
These
Histopath Results:
These intestinal biopsies are excellent, and are definitive for primary lymphangiectasia.
The intestine is structurally normal and has no increase in leukocytes, but every villus lacteal is
massively distended to the point of rupture, and the dilation of lymphatics continues within the
submucosa and tunica muscularis. There is absolutely no evidence of neoplasia, and there is no
evidence of previous inflammation or fibrosis that might explain the development of the
lymphangiectasia. The vast majority of cases of lymphangiectasia that I see in dogs are primary
and idiopathic like this.
DIAGNOSIS:
1. IN BIOPSIES OF PERFECT TECHNICAL QUALITY, PERFECT LESIONS FOR SEVERE
PRIMARY LYMPHANGIECTASIA
BRIAN P. WILCOCK, D.V.M., Ph.D., VETERINARY PATHOLOGIST