– 14 yr old ADR, MN DSH with hyperthyroidism
– multiple issues found on ultrasound
– bloodwork surprisingly boring except for neutropenia, mild anemia and mild hyperglycemia
– I suspect bile duct obstruction due to mass either in the right pancreas or the region (not sure if part of the pancreas)
– left kidney quite abnormal, with a possible mass and renal infarct
– ileocecal and jejual LN’s midly enlarged and hypoechoic
– spleen multiple small hypoechoic nodules
– 14 yr old ADR, MN DSH with hyperthyroidism
– multiple issues found on ultrasound
– bloodwork surprisingly boring except for neutropenia, mild anemia and mild hyperglycemia
– I suspect bile duct obstruction due to mass either in the right pancreas or the region (not sure if part of the pancreas)
– left kidney quite abnormal, with a possible mass and renal infarct
– ileocecal and jejual LN’s midly enlarged and hypoechoic
– spleen multiple small hypoechoic nodules
Where to start?? I did FNA’s of the LN’s and spleen. Could not get to the region of the right pancreas lesion without organs in the way. Cytology pending.
Comments
Well the spleen is big and
Well the spleen is big and nodular and crying for a needle. The mass looks like its in the common bile duct but would need video to confirm. The arrows on my image are indicating what I believe to be the cbd wall and the mass within it would be bile duct carcinoma. You have a direct fna shot at it I would stick it (25g) and the spleen as well and then if the spleen is clean and no liver mets needs bile duct reconstruction. Please load a video of this image if you have one as its so very difficult to make efiinitive calls on stills wihtout video confirmation of a still lesion. Its so easy to get burned so when I read telemed cases I use this rule as well and it holds up
Well the spleen is big and
Well the spleen is big and nodular and crying for a needle. The mass looks like its in the common bile duct but would need video to confirm. The arrows on my image are indicating what I believe to be the cbd wall and the mass within it would be bile duct carcinoma. You have a direct fna shot at it I would stick it (25g) and the spleen as well and then if the spleen is clean and no liver mets needs bile duct reconstruction. Please load a video of this image if you have one as its so very difficult to make efiinitive calls on stills wihtout video confirmation of a still lesion. Its so easy to get burned so when I read telemed cases I use this rule as well and it holds up
I hear ya with just looking
I hear ya with just looking at stills! I have inserted a video clip above. I am trying to follow all of the “tubes” and trying to determine if this is in one of them or coming off the pancreas?
I hear ya with just looking
I hear ya with just looking at stills! I have inserted a video clip above. I am trying to follow all of the “tubes” and trying to determine if this is in one of them or coming off the pancreas?
I think its a hepatic LN as
I think its a hepatic LN as it encompasses the portal vein. Color flow would be helpful here. I think I see a normal cbd in the last end of the clip below the pylorus. FNA would determine
I think its a hepatic LN as
I think its a hepatic LN as it encompasses the portal vein. Color flow would be helpful here. I think I see a normal cbd in the last end of the clip below the pylorus. FNA would determine
I did have the impression
I did have the impression that it was around the portal v as I could scan in and out of it with a nice portal vein coming through the region. Thanks your for help! The potential for a hepatic LN didn’t even cross my mind. I am keeping my fingers crossed that the FNA’s of the other LN’s and spleen may provide some information.
I know it would be much easiser for you if you were driving the probe!
I did have the impression
I did have the impression that it was around the portal v as I could scan in and out of it with a nice portal vein coming through the region. Thanks your for help! The potential for a hepatic LN didn’t even cross my mind. I am keeping my fingers crossed that the FNA’s of the other LN’s and spleen may provide some information.
I know it would be much easiser for you if you were driving the probe!
Cytology results:
LN’s –
Cytology results:
LN’s – hyperplasia
Spleen – benign changes
Ugh!
After the rDVM chatted with the pathologist, there is still a strong suspician for neoplasia despite this. The cat continues to loose weight. The rDVM has decided to start pred and leukeron.
Cytology results:
LN’s –
Cytology results:
LN’s – hyperplasia
Spleen – benign changes
Ugh!
After the rDVM chatted with the pathologist, there is still a strong suspician for neoplasia despite this. The cat continues to loose weight. The rDVM has decided to start pred and leukeron.
run a pcr or parr on the
run a pcr or parr on the slides to assess for lymphoma. CSU for PCR, NC state for PARR or go in sx exlap and cut to the chase
run a pcr or parr on the
run a pcr or parr on the slides to assess for lymphoma. CSU for PCR, NC state for PARR or go in sx exlap and cut to the chase