M(N)
M(N)
- Dauch Mix
- M(N) 18 YO
- Presented yesterday for groaning and shaking, drooling. No change to diet.
- Patient recently diagnosed with E.coli UTI (has recurrent UTIs due to rear end paresis and bladder atony for past 13 years.
- Current TX: Baytril 70mg IM, Cerenia SQ, SQF, butorphanol 3mg IM prn for pain
- BW: CBC – mild anemia, Chem – BUN 27, ALT 137. cpli – abnormal
- Ultrasound exam reveals evidence of mild enteritis with increased intesinal motility without obstructive pattern and moderate nephritis with pyelectasis and quiet pancreas.
- A Gall Bladder Mass measures 1 cm x 1.6cm and is visualized adjacent to the dorsal GB body wall and is not gravity dependent (ie: this mass does not change position with the patient standing)
- CF examination is non-conclusive due to patient movement. The cystic and CBD are not visualized which is a normal finding.
- My DDx – rare tumors; such as, Bile duct carcinoma of the gall bladder vs. Neuroendocrine hepatobiliary tumor vs. Saroma vs. Benign bile concretion
Has anyone seen this type lesion within the Gall Bladder.
rDVM is convince that this is the cause of drooling/groaning /shaking. No pain elicited on probe pressure (neg Murphy’s sign)
One image and clip documents a line coarsing thru the mass. I am thinking that this is evidence that the mass is coming off the GB wall.
Any comments?
Comments
Tom you can add power doppler
Tom you can add power doppler to this to see if there is vascularity. I have seen organized sludge balls with sand attach like this so I’m not convinced 100% its a mass but if pdop says yes then it is. Also I doubt its causing the clinical signs because its not obstructing and is in an innocuous position. With a doxy groaning shaking and drooling I am thinking pain from disc disease or gastritis which may or may not have changes sonographically.
Anyone else-ideas?
Nice post!
Thanks Eric. I did try using
Thanks Eric. I did try using color over this but unfortunately found too much artifact from the patient’s panting.
Regarding the thin line in this image (similar to my recent post on the colon mass)….would this represent part of the GB wall?
Tom you can add power doppler
Tom you can add power doppler to this to see if there is vascularity. I have seen organized sludge balls with sand attach like this so I’m not convinced 100% its a mass but if pdop says yes then it is. Also I doubt its causing the clinical signs because its not obstructing and is in an innocuous position. With a doxy groaning shaking and drooling I am thinking pain from disc disease or gastritis which may or may not have changes sonographically.
Anyone else-ideas?
Nice post!
Thanks Eric. I did try using
Thanks Eric. I did try using color over this but unfortunately found too much artifact from the patient’s panting.
Regarding the thin line in this image (similar to my recent post on the colon mass)….would this represent part of the GB wall?
Tough to say for sure but if
Tough to say for sure but if you look carefully at the video the line you indicate is not continuous with the wall of the Gb in th ebeginning and end of th eclip so I think its something different but we are splitting hairs .. or lines
here too:) Follow up in a week maybe with sedation and pdop and mor emeasurments to assess growth would be great as if its a mass you want it out of there before it extends into the cbd or mets to liver.
Fair enough. Good
Fair enough. Good advice.
Thanks
Tough to say for sure but if
Tough to say for sure but if you look carefully at the video the line you indicate is not continuous with the wall of the Gb in th ebeginning and end of th eclip so I think its something different but we are splitting hairs .. or lines
here too:) Follow up in a week maybe with sedation and pdop and mor emeasurments to assess growth would be great as if its a mass you want it out of there before it extends into the cbd or mets to liver.
Fair enough. Good
Fair enough. Good advice.
Thanks
U bet.
U bet.
U bet.
U bet.