-13-14 year old lab with recurrent episodes of vomiting/regurgitation
-recent onset of anorexia
-elevated SAP, amylase, lipase, abnormal cPLI
I am trying to figure out what the mass is associated with and what it may be. The most likely is the pancreas but I wasn’t able to convince myself it was associated with the duodenum. The owner is considering a FNA.
Thanks,
Suzanne
[videoembed id=7744][videoembed id=7745]
[videoembed id=7746]
[videoembed id=7747]
-13-14 year old lab with recurrent episodes of vomiting/regurgitation
-recent onset of anorexia
-elevated SAP, amylase, lipase, abnormal cPLI
I am trying to figure out what the mass is associated with and what it may be. The most likely is the pancreas but I wasn’t able to convince myself it was associated with the duodenum. The owner is considering a FNA.
Thanks,
Suzanne
[videoembed id=7744][videoembed id=7745]
[videoembed id=7746]
[videoembed id=7747]
Comments
Looks like pancreas right
Looks like pancreas right limb to me. Very nodular and either fibrosis or early mineralization. FNA or core bx to confirm. DDX carcinoma vs nodular hyerplasia and chronic inflammation…my guess is the latter and not carcinoma because carcinoma usually tries to escape the capsule with regional inflammation in my experience and the capsule is in tact in this guy. FNA it and tell us what you get. Beautiful images and solid landmarks!
I’m a bit nervous about
I’m a bit nervous about hitting such a vascular pancreas…but should I be? What size FNA needle would you suggest starting with?
Thanks,
Suzanne
Looks like pancreas right
Looks like pancreas right limb to me. Very nodular and either fibrosis or early mineralization. FNA or core bx to confirm. DDX carcinoma vs nodular hyerplasia and chronic inflammation…my guess is the latter and not carcinoma because carcinoma usually tries to escape the capsule with regional inflammation in my experience and the capsule is in tact in this guy. FNA it and tell us what you get. Beautiful images and solid landmarks!
I’m a bit nervous about
I’m a bit nervous about hitting such a vascular pancreas…but should I be? What size FNA needle would you suggest starting with?
Thanks,
Suzanne
Push the body wall down to
Push the body wall down to the mass so its as close as possible a 22g would likely be fine but use a 25gx 1.5 inch if you want to “gauge” the sample no pun intended. Stick the hypoechoic and variable echogenicities in a woodpecker fashion and if that isnt giving recovery then ‘corkscrew” the needle into the parenchyma by slightly twisting the syringe when you are wooodpeckering the lesion.
You will likely have to have the patient left side down and approach from the right pushing down with your scanning hand to minimize the real estate between needle and pathology. I included a panc bx image on a similar lesion from the atlas 400 cd
http://www.sonopath.com/products/atlas-veterinary-sonographic-pathology-cd-normal-echo-abdominal-sonograms-normal-age-relate
Push the body wall down to
Push the body wall down to the mass so its as close as possible a 22g would likely be fine but use a 25gx 1.5 inch if you want to “gauge” the sample no pun intended. Stick the hypoechoic and variable echogenicities in a woodpecker fashion and if that isnt giving recovery then ‘corkscrew” the needle into the parenchyma by slightly twisting the syringe when you are wooodpeckering the lesion.
You will likely have to have the patient left side down and approach from the right pushing down with your scanning hand to minimize the real estate between needle and pathology. I included a panc bx image on a similar lesion from the atlas 400 cd
http://www.sonopath.com/products/atlas-veterinary-sonographic-pathology-cd-normal-echo-abdominal-sonograms-normal-age-relate