Case Study

Suppurative nonseptic pancreatitis in a 12 yr old FS Labrador Retriever mixed breed dog.

This 12-year-old FS Labrador Retriever cross presented for vomiting and anorexia. The physical exam revealed painful abdomen, moderate dehydration, and weight loss. The initial CBC and blood chemistry was normal while the follow-up blood chemistry 5 days later revealed severely elevated lipase and elevated amylase, mildly elevated SAP and elevated total bilirubin, moderate hypoalbuminemia with a normal urinalysis. The sonogram was performed at the same time as the follow-up blood analysis.

This 12-year-old FS Labrador Retriever cross presented for vomiting and anorexia. The physical exam revealed painful abdomen, moderate dehydration, and weight loss. The initial CBC and blood chemistry was normal while the follow-up blood chemistry 5 days later revealed severely elevated lipase and elevated amylase, mildly elevated SAP and elevated total bilirubin, moderate hypoalbuminemia with a normal urinalysis. The sonogram was performed at the same time as the follow-up blood analysis.

DX

Subacute suppurative nonseptic pancreatitis.

Sonographic Differential Diagnosis

Moderate to severe pancreatitis with peripancreatic inflammation.

Image Interpretation

This image reveals a moderately enlarged and hypoechoic pancreas surrounded by markedly echogenic mesentery and omentum. The pancreatic parenchymal architecture within the affected portion appears to be within normal limits. Video 1: A mass of hypoechoic pancreatic tissue is visible with some areas of loss of architecture, capsular expansion in the near field and mixed hyperechoic parenchymal changes suggestive for a acute and chronic process. Video 2: At the 2 month follow-up sonogram the presentation has significantly reduced in sized however persistent hypoechoic changes are noted with hyperechoic remodeling of the surrounding omentum. Low grade persistent inflammation is likely and may be causing subtle clinical signs.

Outcome

Aerobic and anaerobic cultures were not performed since the patient was already aggressively treated with parenteral antibiotics. The patient responded slowly after 12 days of hospitalization, 3 treatments with plasma expanders and one plasma transfusion. The patient was asymptomatic at a two month follow-up and regained body condition. All blood levels returned to normal at 3 days post discharge except for mild persistent elevation in amylase.

Clinical Differential Diagnosis

Pancreas: severe pancreatitis, neoplasia. Liver: post-hepatic obstruction, diffuse inflammatory liver disease. Kidney: PLE, neoplasia involving pancreas.