- 14 year old mn Lab presented for progressive anorexia and acute onset lethargy
- HR=90, T=100 F, RR=40, abdominal pain noted
- CBC and chem prof wnl except for increased BUN=37
- Abdominal US showed small pockets of free anechoic fluid near the bladder and between the liver lobes, echogenic reactive fat near the gallbladder neck, extrahepatic biliary tract, and between the liver and stomach
- FNA of the effusion was attempted but yielded only blood suggestive of contamination
- 14 year old mn Lab presented for progressive anorexia and acute onset lethargy
- HR=90, T=100 F, RR=40, abdominal pain noted
- CBC and chem prof wnl except for increased BUN=37
- Abdominal US showed small pockets of free anechoic fluid near the bladder and between the liver lobes, echogenic reactive fat near the gallbladder neck, extrahepatic biliary tract, and between the liver and stomach
- FNA of the effusion was attempted but yielded only blood suggestive of contamination
- Primary differential diagnoses included pancreatitis, lymphatic obstruction (neoplasia), and coagulopathy
- Patient was referred to E-clinic where thoracic imaging revealed pericardial effusion and possible heart base mass, clotting times were normal.
- I did not put the probe on the chest because the HR was normal and the hepatic veins were not dilated :(.
- Is all of this echogenic fat seen adjacent to the liver due to increased caval pressure? It seems quite odd.
Comments
The echogenic fat is either
The echogenic fat is either owing to adjacent organ disease such as th eliver here, or form enhancement formt he ascites. FNA of the liver and abdominocentesis should differentiate that. I would try a 25g fna if blood contamination occurred. The Gb looks fine so I doubt its a player.
Clotting time at the E-clinic
Clotting time at the E-clinic were normal. They performed a pericardiocentesis which quickly filled up with blood again. The owners elected euthanasia. So, no answer on the liver but I wonder if abdominal metastases were present. The fat adjacent to the liver was so much more echogenic than the rest of the intra-abdominal fat despite pockets of free fluid througout the abdomen. Oddly, this dog did not have cardiac tamponade (yet).
you don’t have to have
you don’t have to have tamponade to have passive congestion depends on the obstructive nature of a heart based mass. If it obstructs the vena cava inflow even from portions of the mass caudal to your echo window then passive congestion occurs which was likely the issue here. 2 things in heart based masses cause passive congestion, tamponade, and mass obstruction/impingement on the vena cava ionflow into the right atrium.
CT will show the extent of the heart based mass and would be the complete option.
see this case here from the Vimago CT:
http://sonopath.com/members/case-studies/cases/ct-heart-base-tumor-pericardial-effusion-likely-mediastinal-lymph-node-ma
If you are interested in what Ct can do and want a greta overview we have about 100+ CT cases in the archive now all read by Dr Ondreka (http://sonopath.com/about/specialists/dr-nele-ondreka-dipecvdi)
Just search CT in the basic search
http://sonopath.com/members/case-studies/search?text=CT&species=All
Honestly after what I have seen the Vimago CT do and the reads come in, anything sick I would run through the vomago and point and shoot with the probe:) My techs would do all the work and I just get to wield needles:)