Right adrenal mass in a 12 year old FS mixed breed dog

Case Study

Right adrenal mass in a 12 year old FS mixed breed dog

A 12-year-old FS mixed breed dog with an extensive history of urinary calculi and three cystotomies to date was presented for a swollen right hind paw. On physical examination, the skin of the foot was inflamed with alopecia and crusting; there was generalized peripheral lymphadenomegaly, and a firm mass was palpated in the area of the bladder. The only change on CBC was thrombocytosis. On blood chemistry hyperglobulinemia, elevated ALP activity, hypercalcemia, and hypertriglyceridemia was present. Total T4 was within normal limits.

A 12-year-old FS mixed breed dog with an extensive history of urinary calculi and three cystotomies to date was presented for a swollen right hind paw. On physical examination, the skin of the foot was inflamed with alopecia and crusting; there was generalized peripheral lymphadenomegaly, and a firm mass was palpated in the area of the bladder. The only change on CBC was thrombocytosis. On blood chemistry hyperglobulinemia, elevated ALP activity, hypercalcemia, and hypertriglyceridemia was present. Total T4 was within normal limits. Survey radiographs of the abdomen showed urinary calculi, hepatomegaly, and splenomegaly. The patient was treated with antibiotics and Benadryl at home. On follow-up visit three days later, owner reported that the patient had been showing polyuria/polydipsia for a few months. Hypercalcemia of malignancy profile revealed an elevated intact parathyroid hormone and elevated ionized calcium level. Thoracic metastasis was not evident on 3-view thoracic radiographs.

DX

Right adrenal mass

Sonographic Differential Diagnosis

Right adrenal mass.

Image Interpretation

The left adrenal gland was small, isoechoic to surrounding tissues and flat in contour (no image.) The right adrenal gland was composed of a heterogenic mass with focal mineralization that appeared resectable without evidence of caval invasion. No evident metastatic disease was noted.

Outcome

Blood pressure and urine specific gravity testing was recommended in this patient. Depending on the outcome of the specific gravity, LDDST testing for adrenal function may be warranted. Surgical resection of right adrenal mass, cystotomy, and expression of the gallbladder were all advised. The patient was lost to follow-up.

Clinical Differential Diagnosis

Stage IV lymphoma, bladder calculi

Sampling

None taken.

Patient Information

Patient Name : Daphne L
Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 07_00010

Clinical Signs

  • PU-PD
  • Swollen limb

History

  • Cystic Calculi
  • Cystotomy

Exam Finding

  • Alopecia
  • Enlarged Lymph Nodes
  • Palpable mass
  • Skin lesion
  • Swollen limb

Images

Liebrightadrenalmassnocavalinvasioncolorofmass

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • Calcium, High
  • Calcium, ionized high
  • Globulin, High
  • Hypertriglyceridemia
  • PTH high

CBC

  • Platelet Count, High

Clinical Signs

  • PU-PD
  • Swollen limb
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