Hello
I was hoping for some advice on “Rock”. A 7 year old Terrier that is exhibiting signs of IBD. We performed an US today and I believe his duodenum has a slightly abnormal appearence. The mucosal looks thickend. It measures 0.43cm (12lbs dog) and there appears to be hyperechoic flecks in the mucosa that do not appear to be related to the lumen.
I never really noticed it with the convex probe but when I brought out the high resolution probe it seemed abnormal to me so I am not sure if I am making things up or not.
Thanks. Brent
Hello
I was hoping for some advice on “Rock”. A 7 year old Terrier that is exhibiting signs of IBD. We performed an US today and I believe his duodenum has a slightly abnormal appearence. The mucosal looks thickend. It measures 0.43cm (12lbs dog) and there appears to be hyperechoic flecks in the mucosa that do not appear to be related to the lumen.
I never really noticed it with the convex probe but when I brought out the high resolution probe it seemed abnormal to me so I am not sure if I am making things up or not.
Thanks. Brent
Comments
Forgot this JPEG
Forgot this JPEG
This is mucosal speckling….
This is mucosal speckling…. and the GI gods are not sure what to do with it yet… I see it in clinical and non clinical IBD cases and personally think it may be a precursor to mucosal striations but may never progress to this. I really want to do introperative ultrasound on these and get hostopath and invite anyone to get there before I do since I do mobile but if you have a practice and have the oppportunity to do this please post what you find and even publish it.
I would love to do an IOP us on normal bowel, match with mucosal speckling and another with mucosal striations and you may find all 3 of these in the same animal as its most often a regional phenomenon.
I would look for GI issues and watch the albumin on this guy but I see this incidentally often. You are right you wont see this til you use hi resolution which i do on every Gi case but can get lost in the nerdy observation passtime til my other clients start yeling at me for being late to their appointments:)
The more you use that expensive linear on GI cases the more you will see this and more.
Here are some mucosal specific presentations from the search engine
http://sonopath.com/members/case-studies/search?text=mucosal+speckling&species=All
http://sonopath.com/members/case-studies/search?text=mucosal+striations&species=All
Great stuff! Thanks!
The
Great stuff! Thanks!
The owner may consider biopsy and histoPath. I believe we have vit b12 and folate pending.
I could basically trace it from the pylorus to a few cms caudal to the kidney. We have endoscopy at our clinic. I wonder if I could perform an US guided biopsy with the scope because it is all proximal duodenum…….but I’m guessing full-thickness would be more informative and more accurate.
I’ll make sure to update if we go further! Thanks again. Brent
scope with transabdominal
scope with transabdominal ultrasound to localize the lesions… that sounds cool should video it… non invasive sandwich:)
You may get the histopath that way and could watch on US the areas being sampled… but yes IOPUS wiht full thickness would be more precise. The purists would compare the 2 techniques.
Are these speckles not early
Are these speckles not early manifestations of mucosal striations that has been reported with lacteal dilation and lymphangiectasia?
I don’t think it has been
I don’t think it has been well defined Remo do you have anything in your literature bag that helps here?
I see these mucosal speckles nearly every day incidentally so if no GI issues or other Gi/panc.liver presentations to support an issue ad normal albumin I maymention them but don’t go to a clinical explanation…. so in other words I play their importance to the case…
Nothing that I can dig up in
Nothing that I can dig up in the literature. Agree that they need to be interpreted with each individual case but would be great to follow them over a period of time to see what, if anything, develops.
For what is worth, I did try
For what is worth, I did try scoping and transabdominal Us in a couple of patients before cause we have both facilities in clinic in the same room. But as soon as the scope puts the gas then I cannot see anything so it is only a very brief scan window. May be somebody has a tip?
I have also come across this specks in duodenal mucosa in asymptomatic patient. No biopsies, I’m afraid.
Not sure if at all applicable
Not sure if at all applicable but came across this is from a human journal describing speckling seen with video-endoscopy:
Colonic mucosal speckling has been recognized adjacent to neoplastic polyps, non-neoplastic polyps and inflamed colonic mucosa. Speckling was also seen on otherwise normal mucosa. A similar endoscopic appearance can be produced by accumulation of either lipid or mucin within macrophages in the lamina propria.