[videoembed id=7323][videoembed id=7323]This is a 12 year old MN Collie x that we are working up for PLE:
– history of low TP and albumin with chronic diarrhea
– ultrasound showed abdominal effusion and “lung rockets” on TFAST so assume pulmonary interstitial edema starting
– spleen, liver and kidneys normal
– a cystic-type mass was detected at the apex of the urinary bladder that appears to be adherent to and growing from the outside wall indenting the surface; it had very low blood flow seen on colour Doppler
– the hypo gastric LN’s are prominent
This is a strange presentation (to me anyway) for a bladder mass. What would be some differentials? (sorry not labelled but the third still and the clip show the urinary bladder with mass at the cranial aspect and the clip was accidently entered twice)
What do you think of the SI? I did not see mucosal striations that you would expect with lymphangiectasia but the submucosal layer seems a little thick and in many areas the mucosa and the muscularis layer were about the same width in many regions as well. I know biopsy is warranted. (DDx: lymphangiectasia, IBD, lymphoma)
Comments
If the albumin is < 1.5 g/dl
If the albumin is < 1.5 g/dl then the free fluid is likely from 3rd spacing.If higher than that then look for other causes like lymphatic obstruction to enhance the 3rd spacing wiht pressure issues along wiht low albumin. But if there are 2 things going on its possible that apical ub lesion has perfed? In which case the free fluid could be uroabdomen and BUN on azostick of the ascites would be > serum BUN theoretically.
What is the nature of the fluid? If no proteinuria and liver looks ok and no acute hepatitis then a significant albumin drop would have to be intestinal. MS are not essential for PLE just helpful to complete the suspicion.
This bladder lesion is resectable and looks somewhat like a urachocele (remnant) or urachal cyst. Would be nice to kill 2 birds 1 stone sx resection and GI bx, plasma before hand to get t he albumin > 2.0. Im not convinced the ub lesion is neoplastic.
If the albumin is < 1.5 g/dl
If the albumin is < 1.5 g/dl then the free fluid is likely from 3rd spacing.If higher than that then look for other causes like lymphatic obstruction to enhance the 3rd spacing wiht pressure issues along wiht low albumin. But if there are 2 things going on its possible that apical ub lesion has perfed? In which case the free fluid could be uroabdomen and BUN on azostick of the ascites would be > serum BUN theoretically.
What is the nature of the fluid? If no proteinuria and liver looks ok and no acute hepatitis then a significant albumin drop would have to be intestinal. MS are not essential for PLE just helpful to complete the suspicion.
This bladder lesion is resectable and looks somewhat like a urachocele (remnant) or urachal cyst. Would be nice to kill 2 birds 1 stone sx resection and GI bx, plasma before hand to get t he albumin > 2.0. Im not convinced the ub lesion is neoplastic.
Here is a urachal remnant
Here is a urachal remnant that is open to the lumen but other than that looks like your image and is in the right position.
Here is a urachal remnant
Here is a urachal remnant that is open to the lumen but other than that looks like your image and is in the right position.
I thought about the
I thought about the possibility of a urachal cyst but never saw an u/s image of one. Thanks!
I thought about the
I thought about the possibility of a urachal cyst but never saw an u/s image of one. Thanks!