Case Study

Severe pancreatic necrosis in a 6 yr old, FS Pug

Pug, FS, 6 years. Sudden onset vomiting and PU/PD and lethargy. The patient is on Vetsulin, Humulin R, Cefoazolin, Famotidine, Cerenia, Baytril, Furosemide, Metronidazole. Glucose 638-745, Sodium 124, potassium 3.2, Creatinine 6.2, WBC 23K, BUN 83. Radiograph Findings: hepatomegaly

DX

Severe pancreatic necrosis

Sonographic Differential Diagnosis

Severe pancreatic necrosis and abscessation is likely. Ultrasound guided drainage and surgical approach to this case is warranted.
Gastric stasis.
Concurrent splenitis, possible infarcts.
Acute nephritis.
Reactive hepatopathy.
Severe peritonitis.

Image Interpretation

The pancreas in this patient revealed a 6.0 cm x 4.0 cm mixed hypoechoic region of necrosis and/or abscessation with region inflammation. The majority of the pancreatic pathology measured 9.4 cm x 5.3 cm with portions of necrosis and likely, abscessation.

The stomach was dilated with fluid. The remainder of the gastrointestinal tract was unremarkable.

The liver was enlarged, hypoechoic to falciform fat, with increased portal markings and coarse architecture.

The spleen was nodular, heterogenous, with mixed hypo and hyperechoic changes. There is a strong potential for splenitis +/- infarcts.

Outcome

I recommend plasma transfusion in this patient. A temporary solution could involve ultrasound guided drainage of the presumed abscessation and ultrasound guided FNA of the hypoechoic necrosis pattern throughout the pancreas. Aggressive treatment for renal failure and pancreatitis is warranted. Recheck the sonogram in 24-48- hours to assess if surgical intervention with debridement of a large portion of the pancreas would be necessary. Very guarded prognosis, the patient is at high risk for thrombotic events, given the systemic inflammation.