Case Study

Pancreatitis and mesenteric steatitis 10 Year Old MN Weimaraner

This 10-year-old MN Weimaraner presented for anorexia, occasional vomiting, weight loss, and poor body condition. The clinical exam revealed a mildly tender abdomen and mild fever. CBC and blood chemistry analysis revealed moderate leukocytosis with a left shift, slight elevations in amylase and elevated SAP and mild hypomagnesemia.

This 10-year-old MN Weimaraner presented for anorexia, occasional vomiting, weight loss, and poor body condition. The clinical exam revealed a mildly tender abdomen and mild fever. CBC and blood chemistry analysis revealed moderate leukocytosis with a left shift, slight elevations in amylase and elevated SAP and mild hypomagnesemia.

DX

Moderate, chronic-active, necrotizing, pancreatitis and mesenteric steatitis.

Sonographic Differential Diagnosis

Severe pancreatitis with marked adjacent peritoneal inflammation and duodenitis with stasis. Pancreatic necrosis or neoplasia likely.

Image Interpretation

The right limb of the pancreas is markedly enlarged and hypoechoic. The omental and mesenteric fat bordering the pancreas is severely echogenic. In the near field, the descending duodenum is moderately thick walled, however, maintains normal delineation between wall layers. The proximal and distal segments of the duodenum are mildly distended. Lack of distention of the central duodenal segment is likely the result of compression by the ultrasound probe. Color flow Doppler reveals lack of blood flow suggestive for necrosis.

Outcome

The patient, did not respond well initially with intensive hospital care. However, he improved after 1 week of plasma expander fluid protocol and aggressive antibiotics, even though this pathology is not typically bacterial in nature. One month post hospitalization the patient is asymptomatic with close to normal body condition.

Clinical Differential Diagnosis

Pancreatitis, IBD, gastric or duodenal ulceration, neoplasia, foreign body.

Sampling

16-gauge US guided True-cut biopsy was obtained from the hypoechoic region of the pathology in the left pancreatic base. The histopathologic diagnosis revealed moderate, chronic-active, necrotizing, pancreatitis and mesenteric steatitis.