Sonopath Forum

Pancreatitis and odd cyst and duodenal lesion

Chihuahua, FS, 10 years, 10.6#,

This is a patient I scanned recently that has had recurring pancreatitis episodes for the past two years. Amylase and lipase levels are significantly elevated as well as cPLI levels which can range from 550-2000. The cPLI levels to decrease when pet seems to clinically improve. Pet seems to respond most to amoxicillin.

The scan does show significant acute pancreatitis and there is some mild abdominal effusion and the abdominal fat is hyperechoic and hazy. My primary concern is this lesion that is in the near field of the proximal duodenum just distal to the pyloric duodenal junction. It appears to have a small cystic character but as you trace it, it seems to coalesce into the duodenal wall. Its location is not consistent with the major duodenal papilla and I felt like in one video clip I with the the duodenal papilla which appeared normal.

My questions are
1. could this be the duodenal papilla just situated in a abnormal position or could this be a small abscess may be a tumor within the duodenal wall?
2. could this be a source of recurring pancreatitis?

Considered fine needle aspiration, the concern is if this is in the duodenal wall could I cause any kind of damage that could cause intestinal leakage; also pet is fairly painful in the abdomen so it would likely need some heavy sedation as it is a very small focal target.

Will

Comments

DrMac

September 14, 2019 at 4:29 pm -

Hey! Yes I agree the

Hey! Yes I agree the sonographic appearance of the pancreas is consistent with active pancreatitis with surrounding omental inflammation.

In the first clip, there is a small cystic lesion that does not appear to be obviously associated but next to the duodenum. This could be a pancreatic cyst or dilated pancreatic duct.

The concerning cystic lesion that appears to be within the duodenal wall does not appear to be an abscess or tumor and I dont see signs of neoplasia. I think this cystic lesion is likely associated with a dilated pancreatic duct because as you scan medial from the duodenum, the lesion appears to be primarily within the pancreas parenchyma…as opposed to, as you scan more laterally into the duodenum the lesion appears to disappear. So Im thinking its a dilated pancreatic duct, likely inflamed secondary to pancreatitis.

I dont think this is a chronic cause of pancreatitis but secondary to it.

Mac

animage

September 14, 2019 at 5:16 pm -

Great, Thank you for the

Great, Thank you for the input.