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Pyometra or Abdominal Mass

Case Of the Month

Pyometra or Abdominal Mass

Why do we always perform a full abdominal sonogram from diaphragm to pelvic urethra? Simple ovarian tumor and eventual OVH? Even though it may seem so, the prudent clinical sonographer will image the right adrenal gland in full (even if not overtly indicated form the history) and not be satisfied with the simple 2-D right adrenal view.

Dr. Doug Casey of English Bay Ultrasound Service, Vancouver, B.C, Canada gives the practitioner and client something more to think about in this month’s SonoPath November 2012 case of the month.


Why do we always perform a full abdominal sonogram from diaphragm to pelvic urethra? Simple ovarian tumor and eventual OVH? Even though it may seem so, the prudent clinical sonographer will image the right adrenal gland in full (even if not overtly indicated form the history) and not be satisfied with the simple 2-D right adrenal view.

Dr. Doug Casey of English Bay Ultrasound Service, Vancouver, B.C, Canada gives the practitioner and client something more to think about in this month’s SonoPath November 2012 case of the month.

A 13-year-old, intact female Fox terrier was presented for evaluation of possible pyometra or abdominal mass. A mid abdominal thickening was palpable.

Outcome

The owners are considering their options.

Clinical Differential Diagnosis

(Lobetti):

Mass – neoplasia/granuloma/abscess/cyst of spleen, kidney, liver, ovary, intestine, mesentery, lymph node
Hydronephrosis
Splenic torsion
Pyometra

Sampling

FNA revealed granuloma cell tumor of the ovary.

Sonographic Differential Diagnosis

(Lindquist DMV, DABVP): Left ovarian tumor, appears resectable.
Right adrenal gland mass.

Slight invasion or attached thrombus. This is potentially resectable. Right adrenal differentials include adenocarcinoma or pheochromocytoma given the invasive activity, possible adenoma with attached thrombosis.
Recommend ovariohysterectomy and right adrenalectomy in this patient. CT evaluation of the right adrenal could also be considered. Blood pressure measurements and full adrenal gland panel is recommended.

Patient Information

Gender : Female, Intact
Species : Canine

Images

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