A 5-year-old male German shepherd was presented for evaluation of progressive pain, lethargy, anorexia, and hunched back following an episode of abdominal trauma – tried to jump over a large hole and hit his abdomen on the edge of the hole.
A 5-year-old male German shepherd was presented for evaluation of progressive pain, lethargy, anorexia, and hunched back following an episode of abdominal trauma – tried to jump over a large hole and hit his abdomen on the edge of the hole.
Renal hemorrhage with pericapsular and retroperitoneal fluid and tissue proliferation. Potential clot versus neoplasia and secondary hemorrhage.
The left kidney in this patient presented a subcapsular blood clot and hemorrhage escape or possible tumor related escape through the dorsal cortex. This appears to extend outside the capsule. Tissue thickening was noted and extended caudally between the vena cava and aorta. This may represent hemangiosarcoma or other neoplastic event with capsular escape. FNA of the hypoechoic tissue and perirenal space and sublumbar space is recommended to assess for a potential neoplastic event and secondary hemorrhage. Otherwise, exploratory surgery is recommended. However, the patterns extending caudally in the sublumbar and retroperitoneal space will not likely allow for clean resection. The left kidney was severely enlarged at 10.6 cm. The right kidney also presented fluid accumulation in the retroperitoneal space and measured 8.87 cm. Infiltrative process is suspected with potential for a blood clot.
Repeat ultrasound was performed 3 days later:
The right kidney was unremarkable and seems completely resolved. The left kidney now measures 11.76 cm. The free fluid appears to have resolved. The caudal half of the kidney is completely destroyed and likely no longer viable.
Contrast iodine study could be considered. Some pericapsular inflammation was noted. Even if some residual function is noted in the cranial half of the left kidney I strongly recommend a nephrectomy. Color flow assessment of the cranial half of the kidney appeared to be adequate. Heminephrectomy could be considered at the time of surgery, yet there is still a potential of this being a neoplastic process such as hemangiosarcoma. Therefore, surgical exploratory is recommended with likely expectation of left nephrectomy or heminephrectomy if not neoplastic and still viable from a surgical perspective. There was a slight blood clot noted between the vena cava and aorta, yet this appears to be resolving. Therefore, that portion is likely not neoplastic. However, there is still a potential of intrarenal neoplasia, though less likely given that the abdominal presentation appears to be largely resolved and localized around the left kidney. Alternatively, if the patient is stable continuation of supportive therapy could be considered with a recheck of the kidney in approximately 1 week to assess for further potential resolution. If the patient is not stable and still painful then a left nephrectomy would be recommended.
FNA of the hypoechoic tissue is recommended. Guarded prognosis. Recheck sonogram is recommended in 48-72 hours to assess for any progression or resolution. Neoplastic infiltrates and blood clots can look similar on ultrasound. Doppler assessment could not differentiate one or the other hence the necessity for aspirates.
Peritonitis – bile, urine, septic
Renal/splenic/hepatic hematoma
Abdominal/lumbar muscle trauma
Ruptured splenic/hepatic neoplasia
Pancreatitis
Biopsy revealed renal hemangiosarcoma and subcapsular hematoma.
