Sonopath Forum

pancreatitis vs. mass

11 yr MN Rat terrier w/ acute onset vomiting, bloating and abdominal pain over 9 days ago. Serial ultrasounds initially showed possible abscess appearance of the body/left limb but not encapsulated. Began just appearing more hypoechoic. Slightly less thick than initial measurements and minimal effusion that was initially present gone. Right limb prominent and stable w/ less corrugation of the duodenum. Main concern is mineralized appearance in the body. I have not aspirated yet – patient has been doing well and opted for serial scans along side supportive

Comments

February 13, 2017 at 9:05 am -

the near field there is a

the near field there is a solid wall and nebulous far field that fits with inflammation. US guided drainage the way to go here. You can use a mila catheter or a 2 gauge 2 inch IV catheter works well as well. Im guessing you have about 6-8 cc in there to remove. I shoot body wieght does of Baytril right back in. The echogenic floating things are pus or blood clots and I dont see mineralizationa dn dont see anythign that says neoplasia. You can always power doppler these too to help discern pus from tissue.

kromero

February 16, 2017 at 8:52 am -

Thank you, Eric. I was able

Thank you, Eric. I was able to drain about 3 mls tonight – neutrophils w/ intracellular cocci. Injected Baytril back in. I had to use a 1 1/2″ needle and was able to get good access, but not ideal and couldn’t completely drain it. I will have to look in to the Mila catheters. What guage are you using?

February 16, 2017 at 10:11 am -

Mila 18 gauge are usually the

Mila 18 gauge are usually the most useful for anything from peircardial taps to pus pockets.

the rest of that panc is likely necorsis oif not carcinoma in the mix.

rescan it every few days and post the progress if you can to see the healing would be cool to watch the sequence.

Here’s a healing sequence of pancreatitis

http://sonopath.com/members/case-studies/cases/severe-pancreatitis-resolution-after-treatment-12-year-old-fs-chihuahua

Here’s a cool one with gastric mural abscess and pancreatic abscess

http://sonopath.com/members/case-studies/cases/pancreatic-and-gastric-abscesses-10-year-old-keeshond-diabetes-mellitus

This one looks like a pancreatic abscess but is actually a sponge foreign body left from prior surgery:)

http://sonopath.com/members/case-studies/cases/peripancreatic-sponge-foreign-body-3-year-old-mn-pointer-april-2013-com

This is a more common presentation I see with pancreatis abscess without a granulation bed present yet… the body hasnt been able to wall it off yet.

http://sonopath.com/members/case-studies/cases/0500156-molly-s-pancreatic-necrosis-abscess-post-hepatic-obstruction

Here’s a bad abscess but drained and injected with baytril

http://sonopath.com/members/case-studies/cases/0500129-chico-p-pancreatic-abscess

kromero

February 25, 2017 at 5:55 am -

Hi Eric,
Unfortunately I

Hi Eric,

Unfortunately I lost this battle. Iggy presented again about 6 days after draining the abscess and injecting Baytril. I estimate only getting about 2/3 of the fluid present. He had been doing well, but presented restless and painful again. A radiologist we work with did a follow up ultrasound and the abscess was larger and appeared to be adhering to the colon wall and he could not rule out colonic perforation as well. Owners declined surgery and euthanized. The culture from the aspirate grew enterococcus (sensitive to Cipro). Any additional thoughts I might be able to learn form this case?

Thank you,

Kelly

February 25, 2017 at 4:04 pm -

Sounds like something more

Sounds like something more going on feeding the pathology like an intestinal breakdown or something. Explore would have been the way to go if owner would have been willing at that point unfortunately. Sometimes penetrating fb or something can do this… like a toothpick or similar.