14 yo SF Malese presented for intermittent dry hacking cough of two weeks duration. No exposure to other dogs. Acting fine otherwise. Normal thirst and appetite. No V/D.
Medical history: Seasonal allergies (better in last year), Calcium oxalate calculi removed 1 year ago, mild mitral and tricuspid insufficiency(echo 1 year ago), no meds.
PE: Thin haricoat, pot bellied appearance. Otherwise NSF
Lab: Alk phos 1185 doubled from a year ago. Urine Sp Gr. 1.029, 3+ protein, Urine P:C 3.0. (albumin 3.2) remainder of CBC, Biochem NSF
Radiology: Thorax: Heart appears larger compared to last year. No signs of pulmonary edema. Abdomen: very enlarged liver, bilateral renal calcifications.
Abdominal Ultrasound Highlights:
Uniformly enlarged left adrenal measures 1.14 cm cranial pole.
Right Adrenal imaged from left lateral recumbency WNL but plump?
Splenic mass solitary pushing out on capsule.
Left Kidney: mild pyelectasia, small cysts, pelvic calculi, decreased C/M distinction.
Right Kidney: large Cyst
Adominal lymph nodes/ mass? not sure if I’m looking at numerous lymph nodes or is there a discrete mass here. Do you think these are Gastric nodes?
Plan: Echo recheck, Urine culture, Blood pressures, ACTH/Low dose dex. O is very hesitant to do anything invasive but is willing to treat medically.
Especially interested in any thoughts of the lymph nodes/mass.
Thanks!
Comments
Great images Marty! Sorry I missed this thread I was at ACVIM alsways a crazy week. Anyway, I dont like the left adrenal very pheo or carcinoma potentials there. The LN is distroted and losing its length to width ratio and enhanced fat around it. The splenic lesion is expanding on the capsule may be related to the LN (round cell neoplasia potential here) or met from the spleen as adrenal tumors like the spleen as a met site. I would fna spleen and LN for staging, run a bp and urine catecholamine +/- lddst if urine cort creat is elevated (re the left adrenal) or sx explore and remove all 3 unless there are more nodes there. But loioks like im looking at the same one from different angles. Looks like a mesenteric LN. Can fna liver too to ensure no micromets.
Thanks Eric!