Case Study

03-00214 Cheyenne B —NEEDS DX, C—-NO IMAGES—-

A 13-year-old FS retriever cross with history of left adrenelectomy for an adrenocortical adenoma and steroid hepatopathy was presented for not doing right, polypnea, urinary incontinence, and losing his toe nails. The patient was currently on Deramaxx for DJD. On physical examination the patient was QAR, had normal heart and lung sounds, showed polypnea, and the toenails were overgrown toenails. The only abnormalities on urinalysis were isosthenuria and microalbuminuria. CBC was within normal limits.

A 13-year-old FS retriever cross with history of left adrenelectomy for an adrenocortical adenoma and steroid hepatopathy was presented for not doing right, polypnea, urinary incontinence, and losing his toe nails. The patient was currently on Deramaxx for DJD. On physical examination the patient was QAR, had normal heart and lung sounds, showed polypnea, and the toenails were overgrown toenails. The only abnormalities on urinalysis were isosthenuria and microalbuminuria. CBC was within normal limits. Abnormalities on blood chemistry were elevated AST, ALT and ALP activity, and hypercholesterolemia. CBC, Lyme 3DX, and an ACTH stimulation test were all within normal limits. The patient was treated Tramadol with the recommendation to the owner to decrease and then stop the Deramaxx until further diagnostics.

Sonographic Differential Diagnosis

Heterogenous spleen. Likely age related changes. Possible emerging neoplasia. Undefined left lateral liver nodule. Fine-needle aspirates were performed. Possible nodular hyperplasia versus low grade hepatocellular carcinoma.

Image Interpretation

The liver presented a 3.4 cm, left lateral echogenic mass. Fine-needle aspirates were performed on this and spleen. The spleen presented discrete and diffuse hypoechoic micronodular parenchyma.

Outcome

Coagulation panel was within normal limits. The patient was treated with Tramadol and Amoxicillin. Abnormalities on recheck blood work several days later were mildly elevated ALT and ALP activity, and hypercholesterolemia. T-4 was low. Abnormalities on urinalysis were leukocyturia. The patient was also advised for assessment for orthopedic disease due to thoracolumbar spasming that occurred during examination. Muscle relaxants, NSAID therapy, +/- a Dexamethasone trial were all recommended. The patient was presented for recheck examination several days. Further diagnostics were discussed regarding spinal disease, but owner elected to treat the patient palliatively. The patient was discharged with Methocarbamol and Deramaxx.

Comments

Need help making a concise diagnosis out of this information.

Clinical Differential Diagnosis

Liver – acute liver disease (infection, trauma, toxin, drug induced), chronic-active hepatitis, neoplasia Early renal disease Polypnea – diseases of the lungs, heart, pleural space, pain.

Sampling

US-guided FNA cytology revealed low grade hematopoiesis within the spleen and liver as well suspected neuroendocrine epithelial proliferation with evidence of mild-moderate glycogen vacuolar change within the liver.

Patient Information

Gender : Female, Spayed

Species : Canine

Type of Imaging : Ultrasound

Clinical Signs

"Not Doing Right"
Incontinence
Tachypnea

History

Adrenalectomy
NSAID use

Exam Finding

Tachypnea

Blood Chemistry

Alkaline Phosphatase (SAP), High
ALT (SGPT), High
AST (SGOT), High
Cholesterol, High

Clinical Signs

"Not Doing Right"
Incontinence
Tachypnea

Urinalysi

Albumin Present
Isosthenuria Present