05-00067 Chase S Pancreatic carcinoma—–NEEDS RI, SB—NO IMAGES—-

Case Study

05-00067 Chase S Pancreatic carcinoma—–NEEDS RI, SB—NO IMAGES—-

A 12-year-old MN DSH was presented for anorexia, weight loss, and weakness. On physical examination a distended doughy abdomen, small irregular kidneys, and nasal discharge was evident. Abnormalities on CBC and serum chemistry were leukocytosis, elevated BUN, hyperkalemia, hyponatremia, hypochloridemia, and hyperbilirubinemia. Survey abdominal radiographs revealed significant ascites. Blood work done a month prior had been within normal limits.

A 12-year-old MN DSH was presented for anorexia, weight loss, and weakness. On physical examination a distended doughy abdomen, small irregular kidneys, and nasal discharge was evident. Abnormalities on CBC and serum chemistry were leukocytosis, elevated BUN, hyperkalemia, hyponatremia, hypochloridemia, and hyperbilirubinemia. Survey abdominal radiographs revealed significant ascites. Blood work done a month prior had been within normal limits.

Sonographic Differential Diagnosis

The changes were most consistent with pancreatic carcinomatosis or similar neoplasia. Poor prognosis.

Image Interpretation

The abdomen in this patient presented an enlarged pancreatic mass with nodular changes and surrounding free fluid. Multiple liver masses were noted. The kidneys revealed largely normal size and structure, corticomedullary definition and ratio (cortex 1/3 of medulla) were essentially maintained with some age related loss of curvilinear pattern. The cortices presented largely uniform texture with some age related echogenic changes that are not likely of clinical significance at this time. Medullary echogenicity differed distinctly from that of the cortex and no evidence or dilation could be seen. The capsules were acceptably uniform for this age patient without dramatic irregularities. Calculus in the left kidney was noted. Examination of the gastrointestinal tract revealed a stomach and intestine free of stasis, of normal wall thickness, acceptable curvilinear mural detail, and peristaltic activity. No obstructive or overt infiltrative disease was noted. No abnormal lymphatic activity was noted and the abdomen was free of masses and pathological fluid. The urinary bladder, trigone and pelvic urethra presented normal wall thicknesses with anechoic urine and normal tone. No uroliths or sediment were visualized. No evidence of inflammatory or neoplastic changes were noted. The ureters were not visible and considered normal. Both adrenal glands were visualized and recognized as having normal shape, size, position and echogenicity for this breed. The phrenic vasculature, glandular echogenicity and detail were acceptable. The spleen presented a smooth homogeneous parenchyma hyperechoic to liver and kidney. The capsule was smooth without noticeable impingement from within the spleen or from pathology in the adjacent abdomen. The splenic vasculature demonstrated normal volume without signs of congestion, significant contraction, or thrombosis. No evidence of acute or chronic inflammatory, neoplastic, or infarctual changes were noted.

DX

The changes were most consistent with pancreatic carcinomatosis or similar neoplasia.

Outcome

The owner elected for euthanazia.

Clinical Differential Diagnosis

Ascites – modified transudate (liver, cardiac, neoplasia), septic exudate (peritonitis), non-septic exudate (urine, bile, neoplasia, FIP). Acute renal failure, pancreatitis.

Patient Information

Type of Imaging : Ultrasound
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