– 13 year old Labrador Retriever presented for weight loss (about 3-4kg)
– bloodwork pending
– 3 view chest rads clear of mets, heart normal in size, liver small, rounded edge
-on ultrasound I could not see any left liver tissue (almost like the left liver was removed)
– right liver nodular, small, rounded edges (see clip with spleen in near field, right liver and right kidney)- spleen had mutiple hyperechoic and hypoechoic nodules present as well as an isoechoic mass in the body with a complex echotexture
– 13 year old Labrador Retriever presented for weight loss (about 3-4kg)
– bloodwork pending
– 3 view chest rads clear of mets, heart normal in size, liver small, rounded edge
-on ultrasound I could not see any left liver tissue (almost like the left liver was removed)
– right liver nodular, small, rounded edges (see clip with spleen in near field, right liver and right kidney)- spleen had mutiple hyperechoic and hypoechoic nodules present as well as an isoechoic mass in the body with a complex echotexture
– a thrombus is present at the aortic bifurcation seen scanning from the right side (non-obstructive)
So differentials: liver:fibrosis/cirrhosis possibly secondary to CAH, neoplasia possible but less likely as the liver is small
spleen: multiple myelolipomas, extrameduallary hematopoesis, benign hyperplasia vs neoplasia (lymphoma, hemangiosarcoma, histiocytic sarcoma, other)
aortic thromboembolism: cardiac disease unlikely, hypercoagulable conditions (neoplasia, Cushings(unlikely), pancreatitis(unlikely), protein losing diseases
I have recommended a coag profile and FNA of the spleen. I don’t think I can easily core biopsy the liver as it is so small and I usually target the left side which appears to be non-existent.
Thoughts on this case? Is Plavix indicated?
Comments
Seems that you have the
Seems that you have the differentials all in order. Liver biopsy/aspirate most likley not going to be of much aid in management of the case. Plavix may help but watch out for possible GI side effects, especially if have chronic liver disease. Please post the results of the blood work as well results of spleen FNA if available.
Seems that you have the
Seems that you have the differentials all in order. Liver biopsy/aspirate most likley not going to be of much aid in management of the case. Plavix may help but watch out for possible GI side effects, especially if have chronic liver disease. Please post the results of the blood work as well results of spleen FNA if available.
Nice image set JP! I would
Nice image set JP! I would start with a 25g fna of that spleen and see if you get neoplasia off of it… MCT or other round cell neoplasia with the weight loss and expansive mixed bag of nodules on the spleen. Run a coag of coarse ideally with ddimer fdp and fibrinogen but if PT and APTT are normal or only mildly elevated and platelets ct > 60k then 25g should be fine and potentially find the culprit. Re liver lower left intercostal IC 11-12 is usually a solid go-to approach in these cases when needed. I’ve never had one I couldn’t access from there if need be even in end stage cirrhosis. But as Remo said likely minimal clinical utility while that spleen is jumping on the probe so start there first. The thrombus isn’t obstructiong yet so I would ignore it til you get a dx.
Nice image set JP! I would
Nice image set JP! I would start with a 25g fna of that spleen and see if you get neoplasia off of it… MCT or other round cell neoplasia with the weight loss and expansive mixed bag of nodules on the spleen. Run a coag of coarse ideally with ddimer fdp and fibrinogen but if PT and APTT are normal or only mildly elevated and platelets ct > 60k then 25g should be fine and potentially find the culprit. Re liver lower left intercostal IC 11-12 is usually a solid go-to approach in these cases when needed. I’ve never had one I couldn’t access from there if need be even in end stage cirrhosis. But as Remo said likely minimal clinical utility while that spleen is jumping on the probe so start there first. The thrombus isn’t obstructiong yet so I would ignore it til you get a dx.
I am envious of your images.
I am envious of your images. They are so clear.
I am envious of your images.
I am envious of your images. They are so clear.
Thanks for the compliment
Thanks for the compliment Randy!
As an update, ALP and ALT were elevated in this patient but not huge. ALT was about 2x’s upper normal but we don’t know if it is on the way up or down. Other parameters normal. In light of the ultrasound findings, I think it is significant. Owner deciding if she wants to pursue splenic FNA as next step.
Thanks for the compliment
Thanks for the compliment Randy!
As an update, ALP and ALT were elevated in this patient but not huge. ALT was about 2x’s upper normal but we don’t know if it is on the way up or down. Other parameters normal. In light of the ultrasound findings, I think it is significant. Owner deciding if she wants to pursue splenic FNA as next step.
With normal proteins unlikley
With normal proteins unlikley to have chronic liver failure and with elevated liver enzymes would think of active liver disease – nodular regeneration, vacuolar hepatopaty, reactive hepatopathy, etc. Spleen still high priority as etiology for the weight loss.
With normal proteins unlikley
With normal proteins unlikley to have chronic liver failure and with elevated liver enzymes would think of active liver disease – nodular regeneration, vacuolar hepatopaty, reactive hepatopathy, etc. Spleen still high priority as etiology for the weight loss.