Case Study

Suppurative, necrotizing pancreatitis, diagnosed on US-guided FNA, in a 10 year old FS diabetic Schnauzer

This 10-year-old diabetic FS Miniature Schnauzer was presented for a 3 week history of not doing right with progressive anorexia and occasional vomiting. The patient had been treated with NSAIDs for the prior 3 months for orthopedic issues. The physical exam revealed slightly tacky mucous membranes and mild abdominal pain. The CBC and blood analysis demonstrated mild regenerative anemia and mildly low leukocyte counts.

This 10-year-old diabetic FS Miniature Schnauzer was presented for a 3 week history of not doing right with progressive anorexia and occasional vomiting. The patient had been treated with NSAIDs for the prior 3 months for orthopedic issues. The physical exam revealed slightly tacky mucous membranes and mild abdominal pain. The CBC and blood analysis demonstrated mild regenerative anemia and mildly low leukocyte counts. The blood chemistry demonstrated severely elevated triglycerides, moderately elevated SAP, moderately elevated cholesterol, moderately elevated BUN, moderately elevated amylase, moderately elevated lipase, and moderately elevated glucose.

DX

Necrotizing pancreatitis

Sonographic Differential Diagnosis

Pancreatitis, necrosis with regional avascular tissue. There is potential for carcinoma or other neoplasia.

Image Interpretation

A mixed hypoechoic, partially avascular portion of pancreas is present consistent with pancreatitis. Doppler of the pancreas shows a lack of blood flow consistent with sequestered necrosis.

Outcome

The patient responded well to 5 days of hospitalization with complete return to normal appetite and clinical status after 3 weeks of outpatient therapy. Two months later the patient was euthanized due to renal failure.

Clinical Differential Diagnosis

Pancreatitis, gastroenteritis with possible NSAID-induced ulcerative disease, neoplasia, sepsis, toxin exposure.

Sampling

22 and 25-gauge US guided FNA revealed chronic active mixed suppurative lymphocytic hemorrhagic, and necrotizing pancreatitis. Culture and sensitivity of the same specimens revealed heavy growth of Serratia marcescens.