This case is presenting a challenge I need some good ideas. This is a 7 yr old f/s golden. She presented to an associate in May for ADR. Her bloodwork showed albumin 1.8 and ++++ preoteinuria on dipstick. Afew days later she was at the ER with diarrhea. The associate saw her again and she had ascites. I imaged the abdomen and found ascites the images of the bowel I have uploaded and a 4 cm rounded likely lymph node. Being a golden i thought the worst and shipped her down to the referral center. Two days later the internist and onco couldn’t find the ascites or bowel changes.
This case is presenting a challenge I need some good ideas. This is a 7 yr old f/s golden. She presented to an associate in May for ADR. Her bloodwork showed albumin 1.8 and ++++ preoteinuria on dipstick. Afew days later she was at the ER with diarrhea. The associate saw her again and she had ascites. I imaged the abdomen and found ascites the images of the bowel I have uploaded and a 4 cm rounded likely lymph node. Being a golden i thought the worst and shipped her down to the referral center. Two days later the internist and onco couldn’t find the ascites or bowel changes. The dog had been on lasix. They fna the spleen which read normal and the intestine which was not a dioagnostic sample. She landed back with me. I again found ascites. I sampled and it is a transudate. Put her on hypoallergenic diet , metronidazole and she’s ok , sort-of. The ascites is less but present the mesentery is hyperechoic the lymph node resolved the bowel not clearly abnormal. checked the right heart it’s ok. portal velocity is normal liver normal. her albumin now 1.4. no diarrhea. No follow up urine at this point awaiting that.b12 and folate elevated. would anyone send her for ct or mri? Has anyone used the aNCA( antineutrophilic cytoplamic antibody) testing for IBD or vasculitis. Is it even done in USA called couple large labs and it was no?I can’t convince myself this isn’t neoplasia.Thanks
Comments
There is loss of detail on
There is loss of detail on the still images but video would be better. FNA that intestinal region of detail loss is indicated as the ascites may be paraneoplastic form lsa or similar. You can do an ascotes spin down and slide prep looking for exfoliating neoplasia. But with PLN, AT3 loss is an issue and I have seen portal thorbosis poccur and prehepatic portal hypertension which would form ascites. So you would need to image the pv at the hilus and add CF and power doppler. Such cases may be found in the search:
http://sonopath.com/members/case-studies/search?text=portal+thrombus&species=All
Ok I did spin the transudate
Ok I did spin the transudate and sent to path nothing useful. the intestinal fna was non-diagnostic. I didn’t do the portal at the hilus. I did do cf thru the abdomen that was ok. I’ll revisit the portal hilus. CT or MR would they show more do you have an opinion? thanks
I suspect all the tissues
I suspect all the tissues would be edematous at this time with an Albumin at 1.4. May just be due to the PLN.
How committed are the owners?
I suppose you could treat for the PLN and if that did not raise the albumin then as a last ditch effort you could treat for PLE with diet and steroids.
they are willing to do
they are willing to do things. Yes everything is glowing in there. That’s exactly what i was thinking go for the pln and steroids by last resort.the owner doesn’t want to open her up just to look around.I’ve got her on hypoallergenic diet.the dog actually feels pretty good!
With an albumin that low I
With an albumin that low I don’t think it would be wise to open her up. Just would not heal.
Agreed!
Agreed!