An 11 year-old NM Labrador was presented for evaluation of weight loss. On a previous ultrasound, a nodule within the left adrenal gland and a normal right adrenal gland was present. Low-dose-dexamethasone test and blood pressure were both normal.
An 11 year-old NM Labrador was presented for evaluation of weight loss. On a previous ultrasound, a nodule within the left adrenal gland and a normal right adrenal gland was present. Low-dose-dexamethasone test and blood pressure were both normal.
The right adrenal gland was more heterogenous than the prior sonogram and measured 2.87 cm, 1.16 cm at the cranial pole and 0.5 cm at the caudal pole with rounded contour. The right adrenal gland appears more regular than the prior sonogram. The left adrenal gland revealed a persistently expansive nodule that measured 1.25 x 3.0 cm, which has increased by approximately 30% compared to the prior sonogram. The left adrenal gland is more enlarged and measured 3.96 cm in length. The left adrenal gland imaged from the right side revealed phrenic vein that appeared to be occupied with slight protrusion into the vena cava in this patient.
I strongly recommend left adrenalectomy as soon as possible. Inspection of the right adrenal gland should also be performed at the time surgery. The phrenic vein invasion or occupation could represent a thrombus; however, given the architecture this would be more consistent with invasive neoplasia. I am most concerned for emerging p or adenocarcinoma. Hyperplasia with phrenic vein thrombus is also possible, yet still pathological and necessitates removal.
Pheochromocytoma, adrenal carcinoma, metastatic adrenal neoplasia
