Case Study

Right adrenal mass with invasion into caudal vena cava in a 12 year old MN Corgi

A 12-year-old neutered male Corgi dog was presented for evaluation due to recurrent hemorrhagic diarrhea. Fecal analysis was negative. Laboratory testing showed hypoalbuminemia, hyperglobulinemia, and elevated liver enzyme activity.

Sonographic Differential Diagnosis

Invasive right adrenal gland mass, suspicious for pheochromocytoma or adenocarcinoma. The prognosis is poor given the CVC invasion.

Image Interpretation

The right adrenal gland comprised a mass that invaded the vena cava and measured 4.63 x 2.25 cm. The majority of the mass was within the vena cava. The right adrenal gland mass itself measured 2 x 2.5 cm with invasion through the phrenic vein of 0.47 cm in width and expansion into the vena cava. The left adrenal gland was uniform in size and contour measuring 2.26 x 0.7 cm. Minor mineralization was noted in the left adrenal gland.

DX

Adrenal mass with caval invasion

Outcome

None

Comments

Serial blood pressure measurements and full adrenal gland panel at the University of Tennessee is recommended. Antihypertensives are recommended if any systemic hypertension is present. Plavix therapy could be considered in order to potentially reduce any attached thrombus to the mass and enhance caval flow. However, this is a palliative measure.

Clinical Differential Diagnosis

GI disease (IBD, neoplasia, foreign body, intussusception, dietary hypersensitivity), hepatic disease (chronic liver disease, fibrosis, granulomatous disease, neoplasia), multiple myeloma, focal peritonitis, vector-bone disease (ehrlichiosis, anapalsmosis).