Telemed case from one of my SonoPath clients Andi Parkisnon RDMS in Baltimore (Intrapet Imaging). This is a controlled Cushings dog with presumed PDH on Trilostane with the usual sap and triglyceride issues but cortisol is 3/5 so controlled but presented for intermittent tachypnea…??? Clot shower???. Adrenals like to necrose and form thrombi in the phrenic vein which is what I suppose is happening here since the rest of the adrenal is uniformly plump and not mass like.

Telemed case from one of my SonoPath clients Andi Parkisnon RDMS in Baltimore (Intrapet Imaging). This is a controlled Cushings dog with presumed PDH on Trilostane with the usual sap and triglyceride issues but cortisol is 3/5 so controlled but presented for intermittent tachypnea…??? Clot shower???. Adrenals like to necrose and form thrombi in the phrenic vein which is what I suppose is happening here since the rest of the adrenal is uniformly plump and not mass like. Any time you see a “bump” (arrow) in the middle of the adrenal always drop color over it as this is where the phrenic (abdominal) vein is and enters into the cvc and is where nearly all adrenal tumors invade and cannot be distinguished from a thrombus easily. There are 2 things that do this invasive adrenal neoplasia usually with a mass on the adrenal that this doesnt have… or a phrenic thrombus that can be caused by any hypercoagulable state… Cushings, diabetes, sepsis, neoplasia, renal failure, liver failure , protein losing disease…… maybe hypertension..….

Going to Tx plavix check BP and rescan in 7-10 days… any other thoughts?