13 yo MN Whippet. U/s for mild elevated liver enzymes. Asymptomatic. On Benazepril and Telmisartan for proteinuria.
First u/s a month ago, mass effect near or in the cranial pole of R adrenal, 1.3cm. Large liver with ill-defined hypoechoic areas. FNA declined. Plump L adr for a 35# dog (7-8mm).
Recheck u/s a month later: liver is the same, cystic jejunal LN (not seen last time). Hypoechoic Mass effect near cr pole of R adrenal is now 2.6-2.8cm, poor blood flow.
Is that a mass on the right adrenal pole? or near it? Pheo? ADK?
Thanks!
Julie
Comments
The poor blood flow may be
The poor blood flow may be because of beam attenuation. Try SDEP 13 & 14 approach more lateral and get the body wall closer to the mass and evaluate the cvc along with the mass to check invasion. Pheo or carcinoma suspected. Check for hypertension and urine catecholamoine for pheo. CT for sx planning.
Thank you so much for your
Thank you so much for your input. Your adrenal lecture is paying off every day! Rec BP and metanephrine test. Older patient, not sure they will go for CT and surgery. If I get to recheck her, I will do your lateral scanning approach.
🙂 you bet
🙂 you bet
Sad update.
Patient came in
Sad update.
Patient came in after a collapsing episode 2 weeks ago (a month post scan). Owner said he was panting and anxious, then collapsed. He was hypotensive and very depressed at admission. I happened to be there, so I rechecked him. The R adrenal mass was about the same size, no free fluid. However, his jejunal LN were huge (2cm). The LN were less than 1cm a month before. They were not able to stabilize his BP and Owner declined referral. Patient was euthanized. Sad story.
Sounds very pheo to me.
Sounds very pheo to me.
yes, scary tumors for sure!
yes, scary tumors for sure! They had declined CT scan and referral last month.