- 9 year old FS Labrador Retriever presented for large, fast growing, caudal abdominal mass, and acute onset rear leg lameness
- CBC is wnl, Chem prof shows ALB=1.8. Chest rads showed no metastatic disease. Rear leg rads were nonremarkable 2 weeks ago.
- 9 year old FS Labrador Retriever presented for large, fast growing, caudal abdominal mass, and acute onset rear leg lameness
- CBC is wnl, Chem prof shows ALB=1.8. Chest rads showed no metastatic disease. Rear leg rads were nonremarkable 2 weeks ago.
- Abdominal ultrasound shows a large, cavitating splenic mass with adjacent reactive fat, a small amount of free anechoic fluid, a 1.3cm, solitary, hypoechoic nodule in the left liver, left renal pelvic dilation (0.9cm) with nodular cortical changes, and a thickend apical bladder wall. This dog is on trilostane for Cushing’s disease and has mildly, symmetrically enlarged adrenal glands consistent with the disease.
- My primary differentials for the splenic mass are HSA, fibrosarcoma, and less likely benign hemangioma.
- My concern is with the changes in the left kidney. My primary differentials are pyelonephritis, ueteral obstruction (from the splenic mass), metastatic disease, and less likely previous renal insult (infection, stone).
- Just wondering what the likelihood of metastatic disease is since this the owners are considereing splenectomy.
Comments
I would be concerned that
I would be concerned that there is a mass on that caudal pole. Can you get a FNA? It would obviously be better to know before exploratory. Nodule in the liver is a worry too. Don’t forget to check the heart for hemangio.
I’m not seeing a splenic mass
I’m not seeing a splenic mass in these images but the left kidney is thick, swollen wiht pyelectasia and an irrgularly dilated ureter in video 2. I would fna the renal cortex and follow that ureter to see what is obstructing it… not sure if im missing something here.
The splenic mass is huge and
The splenic mass is huge and fills much of the abdomen. The deep 1.3cm hypoechoic liver nodule is quiet looking but still suspicious because of all of the other intra-abdominal pathology. The owners have opted not to pursue surgery or any more diagnostics. The splenic mass was not palpable two weeks ago and so I suspect it grew very fast. The acute onset rear leg lameness is also odd and I wonder if this could be a metastatic sarcoma that may not have been visible on the limb radiographs two weeks ago.
Did you happen to depp deep
Did you happen to depp deep pelvis inlet/groin views as HSA grows off the iliacs somethimes as well
No, I did not, but that is an
No, I did not, but that is an excellent suggestion for next time I have a similar case. The patient was sedated prior to my arrival so I just did not think much about the lameness until after her exam.