Kona has a heart based mass and a liver mass. PCV/TP is WNL. Presenting for unrelated symptoms (ivermectin toxicity in a collie mix). This looks right auricular to me, but not cavitated and very large. In this anatomic location, is a chemodectoma a possibility? The liver mass also looks very hemogenous and non-cavitated, making me question if they are related. I know we can’t say tumor type from gross ultrasound appearance, but mainly sending these in as I am still insecure about saying right auricular mass with certainty.
Kona has a heart based mass and a liver mass. PCV/TP is WNL. Presenting for unrelated symptoms (ivermectin toxicity in a collie mix). This looks right auricular to me, but not cavitated and very large. In this anatomic location, is a chemodectoma a possibility? The liver mass also looks very hemogenous and non-cavitated, making me question if they are related. I know we can’t say tumor type from gross ultrasound appearance, but mainly sending these in as I am still insecure about saying right auricular mass with certainty.
Comments
Any chance this could be
Any chance this could be outside the heart and just compressing. Reminds me a bit of this case I posted to the forum. I guess we will wait to see what EL has to say.
https://sonopath.com/forum/heart-base-mass
yes, very possible that this
yes, very possible that this is ouside of the heart or atypically associated with the heart. The mass does not seem to originate from the ascending aorta as most chemodectomas. Perhaps it is originating from the carotid body rather than aortic body. I always try (at least try!) to associate with concurrent findings, so why not a lymph node or atypical cardiac mass (mast cell neoplasia, lymphoma)… to associate with a hepatic mass.
Radiographically the mass is mostly associated with the cranial heart base, as the mid thoracic trachea is dorsally displaced (not really the caudal segment or bifurcation). So anything associated with the right atrium, right auricle, aortic root, tracheobronchial LN would be fair game. However the right atrium and auricle seem unaffected and I do not see the mass surrounding the aorta.
BTW I have grown to dis-respect the term “carina”. I used to use this term to imply the tracheal bifurcation, because tracheal bifurcation required more words and radiologists are lazy. However, “carina” means the obvious “ridge” (=”keel” for latinophiles) of tissue seen anatomically or during endoscopy at the caudal aspect of the tracheal bifurcation. Therefore we never see a “carina” on radiographs. Only the tracheal bifurcation … “TB”?… probably not since it would imply something totally different. bob
Any chance this could be
Any chance this could be outside the heart and just compressing. Reminds me a bit of this case I posted to the forum. I guess we will wait to see what EL has to say.
https://sonopath.com/forum/heart-base-mass
yes, very possible that this
yes, very possible that this is ouside of the heart or atypically associated with the heart. The mass does not seem to originate from the ascending aorta as most chemodectomas. Perhaps it is originating from the carotid body rather than aortic body. I always try (at least try!) to associate with concurrent findings, so why not a lymph node or atypical cardiac mass (mast cell neoplasia, lymphoma)… to associate with a hepatic mass.
Radiographically the mass is mostly associated with the cranial heart base, as the mid thoracic trachea is dorsally displaced (not really the caudal segment or bifurcation). So anything associated with the right atrium, right auricle, aortic root, tracheobronchial LN would be fair game. However the right atrium and auricle seem unaffected and I do not see the mass surrounding the aorta.
BTW I have grown to dis-respect the term “carina”. I used to use this term to imply the tracheal bifurcation, because tracheal bifurcation required more words and radiologists are lazy. However, “carina” means the obvious “ridge” (=”keel” for latinophiles) of tissue seen anatomically or during endoscopy at the caudal aspect of the tracheal bifurcation. Therefore we never see a “carina” on radiographs. Only the tracheal bifurcation … “TB”?… probably not since it would imply something totally different. bob
Mass could be extra-cardiac –
Mass could be extra-cardiac – do you have thoracic radiographs?
Mass could be extra-cardiac –
Mass could be extra-cardiac – do you have thoracic radiographs?
Im pretty sure chemodectoma
Im pretty sure chemodectoma give the position riding the aorta in the second video and echogenicity and looks like the pericardium goes around the mass and no peripheral air bangs like lung masses have… at least not in view. I am betting the liver mass is non related and hepatoma or low grade carcinoma. I stick these chemodectomas if they wish just have to find the clean angle. Liver can stick easily. Rads would help as well.
Thank you, Dr. Lindquist!
Thank you, Dr. Lindquist! Didn’t see your post before I sent the other comment and one view radiograph.
what is an air bang?
what is an air bang?
I see what you mean in the
I see what you mean in the second video.
I assume we are looking at a L apical image and the mass “Pops” in about 4:00.
The aorta is in the center- but I have a question- Just below the arrow in my screen shot- is that part of the wall of the ascending aorta? If so – maybe the mass is just compressing on the aorta.
Just a ? for the sake of argument.
Im pretty sure chemodectoma
Im pretty sure chemodectoma give the position riding the aorta in the second video and echogenicity and looks like the pericardium goes around the mass and no peripheral air bangs like lung masses have… at least not in view. I am betting the liver mass is non related and hepatoma or low grade carcinoma. I stick these chemodectomas if they wish just have to find the clean angle. Liver can stick easily. Rads would help as well.
Thank you, Dr. Lindquist!
Thank you, Dr. Lindquist! Didn’t see your post before I sent the other comment and one view radiograph.
what is an air bang?
what is an air bang?
I see what you mean in the
I see what you mean in the second video.
I assume we are looking at a L apical image and the mass “Pops” in about 4:00.
The aorta is in the center- but I have a question- Just below the arrow in my screen shot- is that part of the wall of the ascending aorta? If so – maybe the mass is just compressing on the aorta.
Just a ? for the sake of argument.
Thanks for your feedback! I
Thanks for your feedback! I have considered the same, but some views/videos shows the heart and mass in very close association. I just tried to upload another video, but could only upload stills from this point. Attached is one radiograph view of the thorax (was performed as a placement rad for feeding tube). Despite a very big bill, we are trying to keep costs down – ivermectin toxicity in a collie breed, rDVM is currently paying the bill. He reportedly did take chest films earlier this month and reported that one of the atria was enlarged, presumedly right, but I have not spoken about the films with him directly. Any thoughts on how to upload one more video?
Thanks for your feedback! I
Thanks for your feedback! I have considered the same, but some views/videos shows the heart and mass in very close association. I just tried to upload another video, but could only upload stills from this point. Attached is one radiograph view of the thorax (was performed as a placement rad for feeding tube). Despite a very big bill, we are trying to keep costs down – ivermectin toxicity in a collie breed, rDVM is currently paying the bill. He reportedly did take chest films earlier this month and reported that one of the atria was enlarged, presumedly right, but I have not spoken about the films with him directly. Any thoughts on how to upload one more video?
Looks cardiac on the
Looks cardiac on the radiograph and dorsal deviation of the trachea and MSB.
Looks cardiac on the
Looks cardiac on the radiograph and dorsal deviation of the trachea and MSB.
Unfortunately secondary video
Unfortunately secondary video upload is technically tough on this OS but if you want to start another thread go ahead. Ill check with IT again and see what the options are… I can tell you form developing sonopath what looks easy on the user end was very complicated on the development end:(
No problem – I know I’m
No problem – I know I’m already pushing the limits of the intended purpose of forum with the number of videos I’ve posted on this case. The other is a video of the still I posted also showing close association with the aorta. Thanks so much for your help on this one. Such a sad case.
Unfortunately secondary video
Unfortunately secondary video upload is technically tough on this OS but if you want to start another thread go ahead. Ill check with IT again and see what the options are… I can tell you form developing sonopath what looks easy on the user end was very complicated on the development end:(
No problem – I know I’m
No problem – I know I’m already pushing the limits of the intended purpose of forum with the number of videos I’ve posted on this case. The other is a video of the still I posted also showing close association with the aorta. Thanks so much for your help on this one. Such a sad case.
Thanks Bob its great to have
Thanks Bob its great to have the radiologist perspective on this.
kromero this is an echogenic mass and likely didnt start to grow yesterday and no pc effusion so things that do that are connective tissue tumors or chemodectomas.. so there may be some quality of life here. Any hepatic vein dilation to see if its growing around the CVC inflow causing cvc and hepatic congestion?
I’ve attached a still of video 2 in that it looks like the mass is on top of the aorta and avvolging it. (small arrows=mass) Video arrow and long arrow pointing to the aorta.
I attached another stilll of a lung mass with the scalloping air interface (arrows) in the periphery as the mass meets the alveoli. In non lung masses there is the pleural echogenic line that separates the lung from a LN or heart mass for example. So when differentiating the lung vs non lung pathology I look for “air bangs” (arrows) interfacing the periphery of the mass or follow an echogenic pleural line separating lung from the mass when drive the probe through the pathology up and down the intercostal spaces. So in MY example lung mass image there is no pleural line separating the mass from the “air bangs” so the mass must belong to the lung because only the lung has air in it… i like to call this “neoplastic creeping” through the bronch-alveolar tree.
I’m sure Bob has more precise terminology on this but they are also called “lung rockets” or “ring downs” or “shower curtain” when diffuse like in pulmonary thromboembolic events…
Here is a basic search on lung masses:
http://sonopath.com/members/case-studies/search?text=lung+mass&species=All
Good thread:)
Thanks Bob its great to have
Thanks Bob its great to have the radiologist perspective on this.
kromero this is an echogenic mass and likely didnt start to grow yesterday and no pc effusion so things that do that are connective tissue tumors or chemodectomas.. so there may be some quality of life here. Any hepatic vein dilation to see if its growing around the CVC inflow causing cvc and hepatic congestion?
I’ve attached a still of video 2 in that it looks like the mass is on top of the aorta and avvolging it. (small arrows=mass) Video arrow and long arrow pointing to the aorta.
I attached another stilll of a lung mass with the scalloping air interface (arrows) in the periphery as the mass meets the alveoli. In non lung masses there is the pleural echogenic line that separates the lung from a LN or heart mass for example. So when differentiating the lung vs non lung pathology I look for “air bangs” (arrows) interfacing the periphery of the mass or follow an echogenic pleural line separating lung from the mass when drive the probe through the pathology up and down the intercostal spaces. So in MY example lung mass image there is no pleural line separating the mass from the “air bangs” so the mass must belong to the lung because only the lung has air in it… i like to call this “neoplastic creeping” through the bronch-alveolar tree.
I’m sure Bob has more precise terminology on this but they are also called “lung rockets” or “ring downs” or “shower curtain” when diffuse like in pulmonary thromboembolic events…
Here is a basic search on lung masses:
http://sonopath.com/members/case-studies/search?text=lung+mass&species=All
Good thread:)
Here is a suspected aortic
Here is a suspected aortic body tumor form the basic search with similar echogenicity and expansion but a little different position.
http://sonopath.com/members/case-studies/cases/aortic-body-tumor-10-year-old-mn-boston-terrier-exercise-intolerance
Here is a suspected aortic
Here is a suspected aortic body tumor form the basic search with similar echogenicity and expansion but a little different position.
http://sonopath.com/members/case-studies/cases/aortic-body-tumor-10-year-old-mn-boston-terrier-exercise-intolerance
Thanks, EL. All of the links
Thanks, EL. All of the links were very helpful. One titled Pulmonary Adenocarcinoma in a Springer Spaniel shows the air bangs within the mass very well. As far as the hepatic vasculature goes, I did not appreciate any congestion, so I also think the liver tumor is low grade or benign and not currently causing a problem. The dog began to have respiratory fatigue, so is now at CSU on a ventillator – nightmare for the rDVM. I’ll let you know what I find out in terms of outcome or if the dog eventually has a necropsy. Thanks again – I learn more from this website in one night than I generally get out of attending an entire general conference!
I don’t fully understand why
I don’t fully understand why the regular veterinarian is picking up the tab. Ivermectin toxicity is obviously an issue but I am not certain you can say his current problems are related.
I don’t mind helping if I make an error- but I sure hate to do it when I am not at fault.
Thanks, EL. All of the links
Thanks, EL. All of the links were very helpful. One titled Pulmonary Adenocarcinoma in a Springer Spaniel shows the air bangs within the mass very well. As far as the hepatic vasculature goes, I did not appreciate any congestion, so I also think the liver tumor is low grade or benign and not currently causing a problem. The dog began to have respiratory fatigue, so is now at CSU on a ventillator – nightmare for the rDVM. I’ll let you know what I find out in terms of outcome or if the dog eventually has a necropsy. Thanks again – I learn more from this website in one night than I generally get out of attending an entire general conference!
I don’t fully understand why
I don’t fully understand why the regular veterinarian is picking up the tab. Ivermectin toxicity is obviously an issue but I am not certain you can say his current problems are related.
I don’t mind helping if I make an error- but I sure hate to do it when I am not at fault.
Sounds like you have covered
Sounds like you have covered all bases kromero. Thank you for the compliment its the best i could ever have heard. Tell friends:)
Sounds like you have covered
Sounds like you have covered all bases kromero. Thank you for the compliment its the best i could ever have heard. Tell friends:)