Case Study

Pancreatic abscess in a 6 year old MN Yorkshire Terrier cross

A 6-year-old neutered male Yorkshire terrier mixed breed dog was initially presented at an emergency referral facility for vomiting and diarrhea. Laboratory testing showed abnormal Snap cPLI, decreased BUN (5), hypokalemia, PCV of 43% and TS at 7 g/dL. Survey radiographs had shown a small amount of gas in the intestines and mild hepatomegaly. A diagnosis of pancreatitis was made and the dog treated with SQ fluids, Pepcid, Cerenia, Baytril, Buprenex and fed a bland diet, which resulted in a marked improvement. Two weeks after treatment, the pet ingested a piece of pizza resulting in episodes of vomiting and diarrhea. The pet was treated with Cerenia, SQ fluids, Buprenex, and Baytril to which there was a transient response. The patient was then re-evaluated for vomiting, depression, weakness, and anorexia. On physical examination, the abdomen was tense on palpation, and the mucous membranes were icteric. Serum chemistry showed elevated ALP (> 2000) and elevated ALT (304) activity.

DX

Pancreatic abscess

Sonographic Differential Diagnosis

Pancreatic mass. Potential sequestrum. Post hepatic obstruction. Suspect carcinoma or other neoplasia.

Image Interpretation

The pancreas contained a 4.0 cm, mixed hypoechoic and focally mineralizing fibrosing mass with sequestrum that appeared to obstruct the common bile duct. The common bile duct was dilated at 0.65 cm and continued with dilation of the cystic duct and gallbladder. The gallbladder was turgid with suspended debris. This is consistent with post hepatic obstruction due to pancreatic pathology.

Outcome

The pet continued to be treated with fluids, antiemetics, pain medications, antibiotics, antacids, and fed frequent small amounts of a bland diet. The pet responded well to the therapy.

Clinical Differential Diagnosis

Pancreatic pathology (pancreatitis, abscessation, neoplasia), hepatic pathology (acute liver disease, abscess, infectious, neoplasia), biliary obstruction (pancreatitis, neoplasia, duodenal foreign body, neoplasia, IBD).