Case Of the Month

Hyperechoic mucosal layer in a 6-year-old FS Havanese: A forum post and Case Of the Month July 2015

A 6-year FS Havanese with history of vomiting (mostly at night and in morning) for a few weeks; no diarrhea. Recent bloodwork found ALB 16, TP 40, GLOB 24 with other parmaters WNL. A fecal was negative. Urine SG 1.035, no protein on chemstrip and urine pro:crea ratio was pending.

DX

Severe primary Lymphangiectasia.

Outcome

Dr. Pankatz: “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 hypoechoic 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 [PLE] (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.” 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.

Comments

A big “Thank You!” to our SonoPath community member Dr. Jacquie Pankatz, B.Sc.,DVM, IVUSS Cert. and owner of Mountain Vista Veterinary Hospital for providing us with this case study and images! This study was sampled from SonoPath’s interactive forum. If you are a part of the SonoPath.com community you can see the full forum thread (it’s a good one!) by clicking here. 🙂

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Sampling

Full-thickness intestinal biopsies were sampled via intraoperative ultrasound.

Image Interpretation

Ultrasound showed an approx. 4cm length of small intestine with a uniformly ill-defined hyperechoic mucosal layer (“mucosal fogging”-EL) with overall normal wall thickness and normal layering; the classic mucosal striations were not seen, but some mucosal speckling was present. The more dramatic lesion (fogging) was segmental rednering IOP-US ideal to delineate and sample.