Case Study

Suppurative pancreatitis and steatitis in a 6 year old Maltese dog of unknown gender

This 6-year-old Maltese presented for diarrhea, poor appetite, and lethargy immediately prior to the sonogram with a history of acute vomiting 2 weeks prior that had resolved without intervention. The patient also presented concurrently with acute anal sacculitis and dermal hot spots. Outpatient therapy with antibiotics proved mildly effective. CBC and blood chemistry analysis demonstrated a normal complete blood count and moderately elevated amylase, moderately elevated lipase, and moderately elevated SAP. Mild hypoalbuminemia was also present initially.

This 6-year-old Maltese presented for diarrhea, poor appetite, and lethargy immediately prior to the sonogram with a history of acute vomiting 2 weeks prior that had resolved without intervention. The patient also presented concurrently with acute anal sacculitis and dermal hot spots. Outpatient therapy with antibiotics proved mildly effective. CBC and blood chemistry analysis demonstrated a normal complete blood count and moderately elevated amylase, moderately elevated lipase, and moderately elevated SAP. Mild hypoalbuminemia was also present initially. A second analysis revealed similar values regarding amylase, lipase, and SAP with new moderately elevated cholesterol and moderately elevated triglycerides and moderate hypoalbuminemia.

DX

Suppurative pancreatitis and steatitis.

Sonographic Differential Diagnosis

Pancreatitis with peripancreatic inflammation or neoplasia with inflammatory component.

Image Interpretation

Pancreatic body is enlarged, irregular, hypoechoic with increased echogenicity in the peripancreatic tissue (Image 1 & 2). One week follow up. Notice marked reduction in size of pancreas, decreased peripancreatic hyperechogenicity (Image 3). FNA of pancreatic body during first exam (Video 1).

Outcome

The owners declined hospitalization and insisted on continual outpatient therapy despite recommendations for more aggressive measures.

Comments

When considering the follow up images of the pancreas, while the affected segment of the pancreas is reduced in size it remains hypoechoic and is now well circumscribed which may indicate that avascular necrosis or abscessation may be occurring. With this type of pancreatic pathology, Doppler assessment for persistence of blood flow is crucial. Lack of perfusion may suggest necrosis or early abscessation and surgery may be indicated if the patient is persistently symptomatic.