Sonopath Forum

Hypoechoic mass

Hello

I was hoping for some opinions on some US images. They are from a 7 year old lab that has been vomiting and has markedly elevated liver enzymes. The GB was markedly thickened and the spleen gave the appearence of being large extending to contact the UB.

Image 1 is of a circular mass just caudal to the liver. I believe it to be a LN. Was hoping for clarification. It is at the 1-2 cm level.

Hello

Image 1 is of a circular mass just caudal to the liver. I believe it to be a LN. Was hoping for clarification. It is at the 1-2 cm level.

Image 2-4 are of hypoechoic mass in the midcranial Rt abdomen close to the cecum. I am unable to tell if they are LNs, fluid filled lesions or fluid filled outpocketings of the cecum.

Thanks. Brent

Comments

tosullivan

December 4, 2015 at 2:22 am -

Sorry. Got the images mixed

Sorry. Got the images mixed up again. The 4th is of the area caudal to the liver. Thanks.

Pankatz

December 4, 2015 at 12:20 pm -

Brent, the 4 th video to me

Brent, the 4 th video to me definitely shows a LN near the pylorus. I think the other hypoechoic structures are most likely enlarged jejunal LN’s as well that could have liquid content from necrosis, abscess formation etc. Could also be just solid but very hypoechoic. Colour Doppler would help over these even if fluid filled as you should be able to see vascularization around the periphery typical of a LN. My other differential would be something like an omental abscess.

Looks like you could easily FNA one of these but I would make sure to try and drain the entire thing before pulling out the needle if you get liquid contents – attach to an extension set and syringe (could have an assistant pull back on the syringe while you direct the needle). Send for cytology and culture.

I don’t think this looks like cecum as there does not appear to bowel wall layering.

We will see what the ultrasound Gods say 🙂

tosullivan

December 4, 2015 at 12:32 pm -

Thanks. I did Doppler them

Thanks. I did Doppler them and there was peripheral vascularizatiin as you mentioned. i think FNA is most appropriate as well but good advice on draining.

i don’t usually see a LN near the pylorus like this. It has a normal appearance to me but do you think the fact I can see it is suggestive of a disease process or is it normally present just more apparent in this patient?

thanks for the comments. Brent

Pankatz

December 4, 2015 at 12:41 pm -

You really shouldn’t normally

You really shouldn’t normally see gastric LN’s, so if you can, it usually is significant indicating neoplasia or reactivity but need to biopsy to determine which

December 4, 2015 at 2:19 pm -

These are hot distorted lymph

These are hot distorted lymph nodes… lsa or similar, occasionally granulomatous like fungal disease…needs fna. Rounded structures that can’t be connected to any of the normal organs are usually LN.

tosullivan

December 4, 2015 at 6:52 pm -

Thanks so much for the

Thanks so much for the comments. Have a great weekend!

Brent