Case Study

US and CT – Right sided adrenal mass with extensive vascular invasion in a 14 year old intact F Jack Russell Terrier dog

This 14 year old intact F Jack Russell Terrier dog presented for vomiting, lethargy, anorexia of 24 hour duration; no diarrhea.

Physical exam: mildly increased respiratory effort, increased bronchovesicular sounds, abdomen moderately distended and painful on palpation.

CBC/Chem/UA: HCT 43.8%, WBC 16.78, Neu 11.55 with bands suspected, Eos 1.97, BUN 53, Crea 5.4, Phos 14.8, TP 5.0 (Alb 2.4, Glob 2.6), AlkP 351, GGT 21, Chol 325, Amy 1827, Na+ 144, K+ 5.2, Cl- 102 Urine Analysis: USPG 1.023, pH, 5.0, 3+ protein, struvite crystalluria, occasional cocci.

This 14 year old intact F Jack Russell Terrier dog presented for vomiting, lethargy, anorexia of 24 hour duration; no diarrhea.

Physical exam: mildly increased respiratory effort, increased bronchovesicular sounds, abdomen moderately distended and painful on palpation.

DX

Rightsided adrenal mass with extensive vasular invasion meeting malignancy criteria- differentials include pheochromocytoma and adenocarcinoma. Concurrent pyelonephritis.

Image Interpretation

US – Right kidney presented slight pyelectasia. Ill-defined pelvic fat also noted suggestive for pyelonephritis. Right kidney measured 5.15 cm. Left kidney measured 4.33 cm in oblique position. Left kidney also presented pyelectasia suggestive for pyelonephritis. Left adrenal measured 0.5 cm, uniform contour. Right adrenal mass was noted with pericapsular inflammatory pattern. The mass measured approximately 4 cm with regional inflammation; appears potentially resectable. No overt evidence of invasion of the vena cava noted. Focal areas of mineralization or necrosis was noted.

Follow-up CT of the abdomen – A rightsided expansile and slightly ill defined adrenal mass of 4 x 3.5 x 3 cm is seen.
The mass reveals extensive invasion into the caudal vena cava obstructing 90 % of the
vascular diameter. Only marginal blood flow is maintained. Collateral perfusion
bypassing the vascular obstruction has developed. The mass itself reveals a
heterogenous attenuation pattern with multifocal mineralization and non-uniform
contrast enhancement. Mild localized retroperitoneal effusion and fat stranding is noted
surrounding the mass. Hypo-attenuating and hypo-enhancing nodules of up to 1 cm diameter are seen within
the left medial and lateral liver lobes. Multifocal iso-attenuating but hypo-enhancing wedge shaped cortical lesions are seen
within the left kidney.

Outcome

Laboratory work up as well as serial blood pressure measurements are warranted for
further definition. Consider ultrasound guided fine needle aspiration of the liver as well as 3 view chest radiographs and cursory US evaluation of the heart for full tumor staging. The prognosis for surgical resection is poor. This would require venoplasty techniques.