AG abcess or Infected Mass?

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AG abcess or Infected Mass?

Hello,

This is a 7 years old GSD mixed, M/N that presented initially with purulent discarge from his left Anal Gland. He was placed on Cephalexin 25 mg/kg Q 12 hours as well as Meloxicam 0.1 mg/kg; after 10 days there is no improvment. Cytology is pending, however in house showed : a large number of degenerative neutrophils as well as a minor population of round cells.

My question : are this images suggestive of a mass, due to blood vessels presence or abcess with severe inflamatory response?

 

Thank you,

 

Hello,

This is a 7 years old GSD mixed, M/N that presented initially with purulent discarge from his left Anal Gland. He was placed on Cephalexin 25 mg/kg Q 12 hours as well as Meloxicam 0.1 mg/kg; after 10 days there is no improvment. Cytology is pending, however in house showed : a large number of degenerative neutrophils as well as a minor population of round cells.

My question : are this images suggestive of a mass, due to blood vessels presence or abcess with severe inflamatory response?

 

Thank you,

 

Comments

randyhermandvm

It certainly looks like it is

It certainly looks like it is lightling up like an X-mas tree.

I am posting a discussion form VIN. What looks like round cells may actually be mesenchymal cells secondary to pyogranulomatous inflammation.

I will try to attach the discussion as a .pdf

 

By the way- I have much better luck flushing out anal sac abscesses and instilling an antibiotic steroid ointment directely in the sacs.

randyhermandvm

It certainly looks like it is

It certainly looks like it is lightling up like an X-mas tree.

I am posting a discussion form VIN. What looks like round cells may actually be mesenchymal cells secondary to pyogranulomatous inflammation.

I will try to attach the discussion as a .pdf

 

By the way- I have much better luck flushing out anal sac abscesses and instilling an antibiotic steroid ointment directely in the sacs.

EL

That’s a hot anal gland for

That’s a hot anal gland for sure and a thick granulation bed pattern around th3 3-8 oclock right side… there are penetrating linear wchoes on the right bottom that are likely scarring or purulent pentrations (medium arrow).

I arrowed up the still image. The areas of the medium and small arrows (regions of capsular detail loss) are the ones to watch sonographically over the next week along with imaging the abdomen particularly the iliac LN to ensure no met pattern. The long arrow shows in tact AG capsule so thats the point of  normal reference. You want tx to create patterns similar to this over the next 5-7 days… baytril clindamyxcin or metro would be my choice here. If you get furthur progressive deviation of curvilienar patterns… i.e looks less and less like the long arrow then needs sx… or just cut it out regardless.

EL

That’s a hot anal gland for

That’s a hot anal gland for sure and a thick granulation bed pattern around th3 3-8 oclock right side… there are penetrating linear wchoes on the right bottom that are likely scarring or purulent pentrations (medium arrow).

I arrowed up the still image. The areas of the medium and small arrows (regions of capsular detail loss) are the ones to watch sonographically over the next week along with imaging the abdomen particularly the iliac LN to ensure no met pattern. The long arrow shows in tact AG capsule so thats the point of  normal reference. You want tx to create patterns similar to this over the next 5-7 days… baytril clindamyxcin or metro would be my choice here. If you get furthur progressive deviation of curvilienar patterns… i.e looks less and less like the long arrow then needs sx… or just cut it out regardless.

vetecho

Thank you both.I found your

Thank you both.I found your explantions and image dissecting very helpfull

Randy thank you for the link. I like cytology, however sometimes when cytology doesn t clarifythe dg then the big picture is what I go with  I did recommend Ag infusion with Surolan but it was to hot and painfull at this time 

vetecho

Thank you both.I found your

Thank you both.I found your explantions and image dissecting very helpfull

Randy thank you for the link. I like cytology, however sometimes when cytology doesn t clarifythe dg then the big picture is what I go with  I did recommend Ag infusion with Surolan but it was to hot and painfull at this time 

randyhermandvm

I should clarify. The only

I should clarify. The only time I instill a sac is with anal-sacculitis. I never instill a potentially ruputred sac. Those ointments are for topical use only. 

I have felt some very thickend sacs that have ruptured because of the severe cellulitis that occurs prior to the rupture that is noted through the skin. 

Once they have ruptured I treat them consdrvativly with antibiotics and pain meds including a NSAID. I don’t every recheck them unless necessary – for about 30 days. 

I have expressed and instilled sacs before they have a chance to heal and have caused a re-rupture. They need time to heal or scar.

Thanks EL- I always learn from your explanation of images.

randyhermandvm

I should clarify. The only

I should clarify. The only time I instill a sac is with anal-sacculitis. I never instill a potentially ruputred sac. Those ointments are for topical use only. 

I have felt some very thickend sacs that have ruptured because of the severe cellulitis that occurs prior to the rupture that is noted through the skin. 

Once they have ruptured I treat them consdrvativly with antibiotics and pain meds including a NSAID. I don’t every recheck them unless necessary – for about 30 days. 

I have expressed and instilled sacs before they have a chance to heal and have caused a re-rupture. They need time to heal or scar.

Thanks EL- I always learn from your explanation of images.

vetecho

Thank you Randy.

Thank you Randy.

vetecho

Thank you Randy.

Thank you Randy.

Pankatz

Hello everyone
Just wanted to

Hello everyone

Just wanted to ad my 2 cents here. I may be old fashion but in my experience anal glands that have ruptured under the skin that cause a severe inflammatory reaction need systemic steroids. Of course in this case you may have something else nasty brewing where biopsy would be best first.  I also like a 30 day course of baytril, something that can penetrate the region.

Pankatz

Hello everyone
Just wanted to

Hello everyone

Just wanted to ad my 2 cents here. I may be old fashion but in my experience anal glands that have ruptured under the skin that cause a severe inflammatory reaction need systemic steroids. Of course in this case you may have something else nasty brewing where biopsy would be best first.  I also like a 30 day course of baytril, something that can penetrate the region.

vetecho

Never tried prednisone but it

Never tried prednisone but it makes sense. Ussualy this abcesses are responding really well to 7-10 days of AB’s and NSAIDs only. Not this one….

 

Thank you JP.

vetecho

Never tried prednisone but it

Never tried prednisone but it makes sense. Ussualy this abcesses are responding really well to 7-10 days of AB’s and NSAIDs only. Not this one….

 

Thank you JP.

Pankatz

No worries Calin! I have had

No worries Calin! I have had a few tough anal gland cases over the years that took some time and pred worked wonders. But I agree most cases clear up in a couple of weeks normally.

Pankatz

No worries Calin! I have had

No worries Calin! I have had a few tough anal gland cases over the years that took some time and pred worked wonders. But I agree most cases clear up in a couple of weeks normally.

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