Case Study

Pancreatic nodular hyperplasia and pancreatitis, diagnosed by US-guided FNA, in a 10 year old Labrador Retriever

This 10-year-old Labrador retriever dog presented for acute anorexia and vomiting. The clinical exam revealed a tender cranial abdomen, moderate dehydration, and tacky mucous membranes. The CBC and blood chemistry analysis revealed moderate leukocytosis with a left shift and mildly elevated amylase and lipase. After 3 days of IV therapy, the bloodwork showed a moderate increase in ALP and bilirubin.

This 10-year-old Labrador retriever dog presented for acute anorexia and vomiting. The clinical exam revealed a tender cranial abdomen, moderate dehydration, and tacky mucous membranes. The CBC and blood chemistry analysis revealed moderate leukocytosis with a left shift and mildly elevated amylase and lipase. After 3 days of IV therapy, the bloodwork showed a moderate increase in ALP and bilirubin.

DX

Pancreatic nodular hyperplasia and pancreatitis

Sonographic Differential Diagnosis

Chronic active pancreatitis with likely nodular hyperplasia. Neoplasia such as carcinoma is possible but is considered less likely.

Image Interpretation

The tissue in the region of the pancreas revealed mixed hypoechoic, marginated, nodular changes with increased irregular echogenic changes to the parenchymal structure. These images are suggestive for remodeling and likely fibrosis. Chronic active inflammation is likely. The dog may also have pancreatic nodular hyperplasia causing some of the changes to the appearance of the pancreas.

Outcome

After 7 days of hospitalization and clinical resolution of symptoms except for minor focal cranial abdominal pain in the area of the upper duodenum, follow-up blood analysis revealed persistent minor hyperbilirubinemia and mildly elevated SAP. This gradually resolved over a 6 week period but corresponds to the persistent evidence of adhesions and low grade inflammation visualized in Image 3. The patient remained focally painful upon imaging of this lesion but was not overtly symptomatic for pancreatitis during this clinical follow-up. The patient remains asymptomatic at 3 months post hospitalization.

Clinical Differential Diagnosis

Pancreatitis with extra-hepatic biliary obstruction, pancreatic or other neoplasia, gastroenteritis, GB mucocele, biliary obstruction with possible perforation.

Sampling

Abdominocentesis of a small amount of fluid localized adjacent to the lesion revealed suppurative exudate with negative cultures at 96 hours. The patient had been treated with antibiotics for the previous 36 hours. 22-gauge US-guided FNA of the lesions presented revealed pancreatic nodular hyperplasia and pancreatitis.