Case Study

Large anaerobic abdominal mass of liver or pancreatic origin in a 9 year old FS Beagle

A 9-year-old FS Beagle was presented for evaluation of acute onset abdominal pain and vomiting. There was no history of foreign body/toxin ingestion or exposure to different foods. Additional history was hypothyroidism controlled with soloxine. On physical examination, ptyalism and a painful tense abdomen was present. Abnormalities on CBC and serum biochemistry were elevated hematocrit (57%) mildly elevated lipase, and low chlorine. SNAP cPL was negative. Survey abdominal radiographs showed a large central abdominal mass.

DX

Large mass with air accumulation occupying the area of the pancreas but possibly attached to the liver

Sonographic Differential Diagnosis

Large mass with air accumulation. Appears to be occupying the area of the pancreas, but it may be attached to the liver. Air accumulation in the right liver parenchyma. This is likely deriving from a pancreatic mass with anaerobic bacteria entering the portal system or the mass is deriving from the liver with anaerobic infection extending through the biliary tree. Fluid and peritonitis is noted.

Image Interpretation

A 10+ cm, complex, significantly inflamed mass was noted in the midcranial abdomen in this patient. This extends caudally to nearly the urinary bladder. Air accumulation was noted within the mass, which would suggest anaerobic infection by gas producing bacteria. This appears to be occupying largely the area of the pancreas; however, it impinges upon the liver and may potentially be attached to the liver. The remainder of the liver cranially appears to be unremarkable. Therefore, this mass has a strong potential for resection. The right liver presented air accumulation within the liver parenchyma itself, which would either be deriving from a pancreatic mass with anaerobic bacteria entering the portal system or the mass is deriving from the liver with anaerobic infection extending through the biliary tree. Free fluid and peritonitis was noted. Many portions of the pancreas were obscured owing to this mass.

A slight amount of free fluid was noted in the caudal abdomen. A large amount of abdominal fat was noted.

Outcome

immediate exploratory surgery is recommended after plasma transfusion ideally with significant debulking. Enrofloxacin, Clindamycin combination is recommended. Very guarded prognosis.