13 yr FS DSH recently dx w/ hyperthryoidism. Also has liver enzyme elevations: ALT 132, ALP 230, T bili 3.9. Poor appetite and losing weight. Difficult time scanning region of left pancreas. Seeing mass effect that communicates with dorsal liver and is mostly dorsal to the portal vein, but have some insecurity that it may be pancreatic or lymphatic in origin. Would love some input.
Rest of liver is enlarged, but homogenous. The spleen is also enlarged and has a mildly irregular capsule, homogenous parenchyma. Prominent lymph nodes, but all < 0.55 cm.
Comments
These look like large
These look like large distorted lymph nodes and wiht that LE profile and bilirubin up diffuse hepatic lymphoma swould be my concern. I would fna liver and these LNs for the dx.
Thank you Eric. To approach
Thank you Eric. To approach the lymph nodes, right lateral recumbency to help avoid the stomach and portal vasculature?
Wherever you can get the cue
Wherever you can get the cue ball as close to the 8-ball for accuracy:) no rules here but im thinking dorsal recumbence push down on midline but its a whatever works scenario to minimize probe to target distance