Case Study

Adrenal mass with caudal vena caval invasion in a 12 year old FS Golden Retriever

A 12-year-old FS Golden Retriever with history of previous foreign body ingestion was presented for PU/PD and trouble walking over the course of several months. The only significant finding on physical examination was a 10-pound weight loss. Trace hematuria and leukocyturia was evident on urinalysis. Abnormalities on CBC and blood chemistry included anemia, elevated ALP and GGT activity, hypercholesterolemia, hyperamylasemia, and hyperkalemia. 4DX results were negative, and T4 was low. The patient was treated with Rimadyl, Soloxine, and cephalexin. Abnormalities on recheck urinalysis a month later were inappropriate specific gravity, hematuria, 3+ proteinuria, 1+ leukocyturia, and presence of epithelial cells. On CBC reticulocyte count was high and the reticulocyte production index elevated. T4 was within normal range.

DX

Invasive right adrenal gland mass, hepatic and renal metastatic type lesions.

Sonographic Differential Diagnosis

Aggressively invasive right adrenal gland mass with multiple hepatic metastatic-type lesions as well as renal metastatic lesions.

Image Interpretation

The abdomen in this patient presented a large right adrenal gland mass invading the vena cava with metastatic masses in the liver, kidneys and potentially left adrenal gland, which presented nodular changes with similar echogenicity to that of the kidneys. Shower curtain lung field was noted, which is highly suggestive of metastatic disease. Thoracic radiographs would be warranted.

Outcome

A very poor long-term prognosis was given. A biopsy procedure was discussed, but owners declined, settling on palliative care. The patient was treated with prednisone.

Comments

Eventually the patient was humanely euthanized.

Clinical Differential Diagnosis

PU/PD – renal disease, liver disease, Cushing’s disease. Hypothyroidism, euthyroid sick. Bladder pathology – neoplasia, cystitis, uroliths. Degenerative joint disease.