Bob is a 5 yo outdoor DSH with history of large bowel diarrhea for 15 days (with mucus and sometimes hematochezia). No weight loss or decreased apettite.
Initial Lab work: FIV/FeLV negative, UA normal (unfortunately wasn’t able to do till now CBC or biochem due to severe financial restraints), presence of Ancylostoma sp. in the stools
Bob was dewormed and put on an intestinal diet and some pre/probiotics.
Bob is a 5 yo outdoor DSH with history of large bowel diarrhea for 15 days (with mucus and sometimes hematochezia). No weight loss or decreased apettite.
Initial Lab work: FIV/FeLV negative, UA normal (unfortunately wasn’t able to do till now CBC or biochem due to severe financial restraints), presence of Ancylostoma sp. in the stools
Bob was dewormed and put on an intestinal diet and some pre/probiotics.
After a week and half he did not improve at all, so I choose to do an abdominal US. I found mild/moderate splenomegalia with a somewhat patchy pattern (could it be extramedullary hematopoiesis? or maybe lymphoma? or nothing at all?), thick jejunal wall, jejunal lymphadenopathy, and a mucus colonic pattern.
Bob was now put on a hydrolised protein diet and we started metronidazole PO BID. Our next step would be to do the CBC/Biochem and FNA or biopsy the spleen/lymph nodes, but I’m thinking the owners will reject that, at least in the next days (maybe weeks).
I’m new at abd US, is my interpretation correct? (sorry for the dark image on the spleen)
Any feedback on this case would be appreciated.
Comments
Nice image set. The spleen
Nice image set. The spleen could be either reactive or early mct/lsa note the micronodular changes and slight scallopping contour to the capsule and > 1 cm in width all of which is wanting for a 25 g fna:)
This with the jejunal LN which is changing th econtour and not strictly egg shaped. Still reactive LN possible but ruling out lsa is crucial here wiht splenic and LN fna. Then go from there with tx
Nice post
Nice image set. The spleen
Nice image set. The spleen could be either reactive or early mct/lsa note the micronodular changes and slight scallopping contour to the capsule and > 1 cm in width all of which is wanting for a 25 g fna:)
This with the jejunal LN which is changing th econtour and not strictly egg shaped. Still reactive LN possible but ruling out lsa is crucial here wiht splenic and LN fna. Then go from there with tx
Nice post
May be a stupid ? but is that
May be a stupid ? but is that a small loop of bowel consistent with an empty cecum in image 3
May be a stupid ? but is that
May be a stupid ? but is that a small loop of bowel consistent with an empty cecum in image 3
No stupid questions
No stupid questions Randy. We are all on a curve of some sort and either have been where your are or are going to get where you are so all Q are good in SonoPath… that’s what we are about:)
Image 3 is a nice example of the ileocecal junction (ICJ) and Peyer’s triangle as I like to call it because lots of lymphatic action here. Peyer’s patches in ileum and region LN and a gateway for lymph that can get obstructed often and third space fluid (lymphatic strangulation). LSA often starts here especially in cats in my experience and is frequent a keeper of FIP dry and wet forms, MCT and granulomatous disease so get used to hanging out here with a needle and avoiding the mesenteric artery because needle often needed for a rapid dx just angle away for the blood flow and all is fine.
I’ve attached an arrowed up image. Long arrow is the cecum always on the left with a dirty shadow from gas or stool forming (gas in this case), middle arrow region LN that I discussed above and is the needle target, and the small arrow indicates the “wagon wheel” ileocecal valve/end of ileum to the right. Get used to driving the wagon wheel into the cecum as its a key view when evaluating where a lesion or obstruction is in the GI tract.
We will be addressing this at the Puerto Rico seminar in February in lab and lecture to put a plug out there:)
http://sonopath.com/products
No stupid questions
No stupid questions Randy. We are all on a curve of some sort and either have been where your are or are going to get where you are so all Q are good in SonoPath… that’s what we are about:)
Image 3 is a nice example of the ileocecal junction (ICJ) and Peyer’s triangle as I like to call it because lots of lymphatic action here. Peyer’s patches in ileum and region LN and a gateway for lymph that can get obstructed often and third space fluid (lymphatic strangulation). LSA often starts here especially in cats in my experience and is frequent a keeper of FIP dry and wet forms, MCT and granulomatous disease so get used to hanging out here with a needle and avoiding the mesenteric artery because needle often needed for a rapid dx just angle away for the blood flow and all is fine.
I’ve attached an arrowed up image. Long arrow is the cecum always on the left with a dirty shadow from gas or stool forming (gas in this case), middle arrow region LN that I discussed above and is the needle target, and the small arrow indicates the “wagon wheel” ileocecal valve/end of ileum to the right. Get used to driving the wagon wheel into the cecum as its a key view when evaluating where a lesion or obstruction is in the GI tract.
We will be addressing this at the Puerto Rico seminar in February in lab and lecture to put a plug out there:)
http://sonopath.com/products
Hi again,
First, thank you so
Hi again,
First, thank you so much for your helpful answers.
Second, I convinced the owners to do the FNA and it came back as reactive for the LN and normal for the spleen.
Do you get many inconclusive FNAs on these cases?
Hi again,
First, thank you so
Hi again,
First, thank you so much for your helpful answers.
Second, I convinced the owners to do the FNA and it came back as reactive for the LN and normal for the spleen.
Do you get many inconclusive FNAs on these cases?
Reactive makes sense here
Reactive makes sense here and th espleen is a dynamic organ so when relatively benign or minor reactive spleen you will get unremarkable cytology as long as the sample was solid. So reactive node normal spleen I see as a solid read because it fits wiht the suspicions given the contour of the LN. It wasnt a blown out LN deviating from structure like an LSA node typically does. your cytologist can be your best friend or compromise all you do with a needle when fence dwelling everything…send gifts to the former and stay away form the latter as long as you are sending solid samples that beget solid descriptions of cell population.
Nice workup
Reactive makes sense here
Reactive makes sense here and th espleen is a dynamic organ so when relatively benign or minor reactive spleen you will get unremarkable cytology as long as the sample was solid. So reactive node normal spleen I see as a solid read because it fits wiht the suspicions given the contour of the LN. It wasnt a blown out LN deviating from structure like an LSA node typically does. your cytologist can be your best friend or compromise all you do with a needle when fence dwelling everything…send gifts to the former and stay away form the latter as long as you are sending solid samples that beget solid descriptions of cell population.
Nice workup