Case Study

Focal pancreatitis in a 15 year old FS Jack Russell dog

A 15-year-old spayed female Jack Russell was presented for evaluation of vomiting and anorexia. The dog had had a splenectomy 9 months prior. A collapsing trachea and PU/PD were also noted in the history. Abnormalities on CBC and serum biochemistry included leukocytosis, elevated liver enzyme activity, and azotemia.

Sonographic Differential Diagnosis

Focal right limb pancreatitis. There is a potential for post hepatic obstruction, and possible underlying pancreatic carcinoma.

Image Interpretation

The right limb of the pancreas was dramatically hypoechoic and irregular. A region of tissue measuring 2.5 cm was definitively hypoechoic. This was located at the right pancreatic base and extended to the mid left base. Hyperechoic surrounding fat was noted and extended into the serosa of the upper duodenum, which revealed a hypertrophied muscularis. No loss of detail was noted in the duodenum. There is a mild potential for pancreatic carcinoma. The pylorus revealed muscularis hypertrophy as well as the upper duodenum. Epigastric lymph node was enlarged and measured 0.72 cm.

DX

Focal pancreatits

Outcome

None

Comments

FNA of the hypoechoic portion of the pancreas is strongly recommended. Aggressive pancreatitis therapy will be needed in this patient. Gastrointestinal protectants, pain medications, and antibiotics would be recommended over the next 3 weeks. Guarded prognosis. Pancreatic toxins may be showering the kidneys and exacerbating the clinical renal presentation. Recheck sonogram is recommended in 4-5 days prior to discharge.

Clinical Differential Diagnosis

Renal pathology (chronic kidney disease, acute kidney injury, pyelonephritis, renoliths), pancreatic disease (pancreatitis, neoplasia), hepatic disease (acute hepatitis (viral, bacterial, trauma, toxins), neoplasia, abscess, granuloma), peritonitis.