Case Study

Splenic torsion vs infiltrative disease in a 9 year old FS Bulldog

This 9 year old FS Bulldog presented with lethargy and inappetance of 2 days duration.

Physical exam: MM white, CRT undetectable, abdomen tense with possible mass right mid-abdomen, slight fluid wave

CBC/Chem: HCT 17.4%, WBCs 18,600 with increased neutrophils, Hgb low 6.6, Phos 5.2, Ca low 8.7, alb low 2.4, K+ low 140

This 9 year old FS Bulldog presented with lethargy and inappetance of 2 days duration.

Physical exam: MM white, CRT undetectable, abdomen tense with possible mass right mid-abdomen, slight fluid wave

CBC/Chem: HCT 17.4%, WBCs 18,600 with increased neutrophils, Hgb low 6.6, Phos 5.2, Ca low 8.7, alb low 2.4, K+ low 140

DX

Enlarged, irregular spleen. Possible splenic torsion with free fluid. Infiltrative disease is also possible.

Image Interpretation

The spleen in this patient was enlarged, hypoechoic and irregular with pericapsular inflammatory pattern. A slight amount of free fluid was noted around the spleen. Regional inflammation was noted throughout the area of the splenic fossa. The liver was enlarged, hypoechoic and irregular. The gallbladder was slightly echogenic. The cystic and common bile ducts were normal. No pathological hepatic lymphadenopathy was evident. No overt structural evidence of inflammatory, infiltrative or regenerative pathology was noted. Free fluid was noted throughout the midabdomen.

Outcome

Recommend immediate exploratory surgery with concurrent liver biopsy. The changes
in the liver can be consistent with age related changes or potential early infiltrative
disease. There was no obvious evidence of neoplasia noted elsewhere. Splenic torsion
and splenic infiltrative disease can look very similar sonographically.