Case Study

Suspected pancreatic abscess in a 9 year old MN Labrador Retriever

A 9-year-old NM Labrador Retriever dog was presented for evaluation of acute onset abdominal pain, vomiting, and lethargy. Laboratory testing showed mild anemia, neutrophilia with a left shift, thrombocytopenia, elevated ALP, hypercholesterolemia and hypertriglyceridemia.

Sonographic Differential Diagnosis

Pancreatic abscess, potential for concurrent carcinoma. Ultrasound-guided drainage and FNA of the hypoechoic portion of the pancreatic lesion is recommended.

Image Interpretation

The right limb of the pancreas revealed an abscessing, mixed hypoechoic lesion. The probable abscess measured 3.67 x 1.82 cm. The complete pancreatic lesion measured approximately 5.0 cm. Hyperechoic surrounding fat was also noted. The spleen was uniformly enlarged with relatively uniform parenchyma without evidence of masses. The capsule was mildly swollen. This is most consistent with hypersplenism and reactive hyperplasia deriving from splenic white or red pulp. However, early infiltrative disease such as lymphoma or mast cell neoplasia can also present in this manner. The liver was swollen in contour with minor, heterogenous changes. There was no evidence of biliary disease or post hepatic obstruction was noted.

DX

Pancreatic abscess, potential for concurrent carcinoma.

Outcome

None

Comments

Guarded prognosis. Broad spectrum antibiotics and IV fluid support is recommended.

Clinical Differential Diagnosis

Pancreatic pathology (acute pancreatitis, neoplasia, abscess), pathology of the GI tract (foreign body obstruction, ulceration, gastric torsion), hepatic pathology (acute hepatitis, abscess), cholecystitis, peritonitis (bacterial, bile, urine), renal pathology (abscess, renolith, ureterolith, hydronephrosis).

Sampling

Ultrasound-guided drainage and culture of the apparent abscess as well as injection of Enrofloxacin or similar antibiotic directly into the cavity would be recommended. US-guided FNA of the spleen and liver is also recommended would be best in order to ensure only reactive hyperplasia or other benign processes are present. If clinical signs fit with potential neoplasia or mast cell disease, then Benadryl injection (1 mg/pound IM) 15 minutes prior to FNA would be recommended.