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Adrenal mass in a 12 year old FS Shih Tzu with hypertension

Case Study

Adrenal mass in a 12 year old FS Shih Tzu with hypertension

A 12-year-old SF Shih Tzu dog was presented for evaluation of hypertension that was controlled with 0.625mg amlodipine three times daily. CBC showed mild leukopenia, whereas serum biochemistry was within normal limits.

A 12-year-old SF Shih Tzu dog was presented for evaluation of hypertension that was controlled with 0.625mg amlodipine three times daily. CBC showed mild leukopenia, whereas serum biochemistry was within normal limits.

Sonographic Differential Diagnosis

Right adrenal gland mass. The right adrenal gland mass appears resectable. However, CT verification would be recommended. The vena cava in the region of the right adrenal gland mass appeared free of evident invasion or thrombi. Primary differentials include pheochromocytoma, adenocarcinoma (which may or may not be functional), myelolipoma or regenerative nodule. Given the hypertension, pheochromocytoma is strongly suspected. Surgical intervention with right adrenalectomy and splenectomy would be warranted. If urine specific gravity is less than 1.020, functional adenocarcinoma is possible.

Image Interpretation

The left adrenal gland was uniform with slight, heterogenous parenchyma. No left adrenal gland pathology was noted. The right adrenal gland was comprised of an echogenic mass deriving from the cranial pole and measuring 3.0 cm. There was no evidence of caval invasion. CT evaluation would be warranted to assess potential caval invasion prior to surgical resection. This would explain the hypertension in this patient. The vascularity was mild to moderate.

DX

Adrenal mass

Outcome

The owners have elected to treat Peda palliatively checking BP every month or two, keeping her on current amlodopine dose. Dog is doing well.

Clinical Differential Diagnosis

Essential/idiopathic hypertension, pheochromocytoma, adrenal carcinoma, glomerular disease

Sampling

None

Video

Patient Information

Patient Name : Peda J
Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 07_00106

Clinical Signs

  • Constipation

History

  • Amlodipine therapy

Exam Finding

  • Alopecia
  • Bradycardia
  • Hypertension

Images

20120323090528_095545020120323090528_095803020120323090528_1010560_copy

Blood Chemistry

  • ALT (SGPT), High

CBC

  • Basophils, High
  • Hematocrit, High
  • WBC, Low

Clinical Signs

  • Constipation

Special Testing

  • Coccidioidomycosis Positive
  • Ehrlichia Positive

Urinalysi

  • Amorphous Urate Present
  • Bilirubin Present