HI, this is a 9y2m old 2.4kg male neutered maltese.
-History of: eating a flower (rose) from a hamper 2 weeks ago, following day V+ 3 times and D+ once. After that eating well and feces normal (daily). Then 1 day without passing feces and abd discomfort
-Vitals: WNL, temp 38.8
-CBC/Biochem: normal
-Xrays: constipation. was given fluidtherapy and enema and passed all feces. After that, US.
-US findings: thickened gastric wall and regional Lns. some loss of layering in Antrum mucosa. Fundus WNL. No signs of FB. No other significant findings.
HI, this is a 9y2m old 2.4kg male neutered maltese.
-History of: eating a flower (rose) from a hamper 2 weeks ago, following day V+ 3 times and D+ once. After that eating well and feces normal (daily). Then 1 day without passing feces and abd discomfort
-Vitals: WNL, temp 38.8
-CBC/Biochem: normal
-Xrays: constipation. was given fluidtherapy and enema and passed all feces. After that, US.
-US findings: thickened gastric wall and regional Lns. some loss of layering in Antrum mucosa. Fundus WNL. No signs of FB. No other significant findings.
Question: This thickness (0.6-0.7cm) is likely to be inflammatory, right? Gastric LN is quite round. I usually do not see this Lns. I am worried about the mucosal lining, it appears quite hyperechoic and submucosa quite thick.
Plan is to re-scan in a few weeks (how many should I advice to ensure inflammation is gone, if it is only inflammatory?) and should there still be this finding, then, FNA or biopsy? We can do endoscopic sampling but it may not be diagnostic if not full thickness, am I right?
Comments
Inflammation possible but
Inflammation possible but with the loss of layering, thickened submucosa, and enlarged LN would be worried about emerging neoplasia (lymphoma, carcinoma). Would FNA stomach and LN now rather than wait a few weeks.
Inflammation possible but
Inflammation possible but with the loss of layering, thickened submucosa, and enlarged LN would be worried about emerging neoplasia (lymphoma, carcinoma). Would FNA stomach and LN now rather than wait a few weeks.
I’m seeing mucosal detail
I’m seeing mucosal detail loss but the submucosa is in tact as is th emuscularis and serosa. There is solid peristalsis which is a non neoplastic criteria. The lesions are mucosal so scope should give solid bx restults which is where I would go with this. Sclerosing carcinoma will do this but Im bettering chronic inflammatory and secondary hypetrophy. If empirical approach only then I have had luck with this protocol and recheck in 3 weeks:
Helicobacter/Gastritis protocol
A clinical trial of Zithromax (Dogs: 5-10 mg/kg p.o. q24h. May increase dosing interval to q48h after 3-5 days of treatment), Metronidazole (10-20 mg/kg po bid) , Pepcid ( 0.5-1 mg/kg sid) and Sucralfate (0.5-2 g/dog PO) or Omeprazole (1 mg/kg po sid) over the next 3 weeks along with a novel-protein or hydrolyzed diet with slurry feeding bid/tid. over the next 2-4 days and then increase to canned diet bid. Dry food should be avoided over the next 4 weeks. A recheck sonogram to assess GI improvement or progression would be ideal in 4 weeks.
I’m seeing mucosal detail
I’m seeing mucosal detail loss but the submucosa is in tact as is th emuscularis and serosa. There is solid peristalsis which is a non neoplastic criteria. The lesions are mucosal so scope should give solid bx restults which is where I would go with this. Sclerosing carcinoma will do this but Im bettering chronic inflammatory and secondary hypetrophy. If empirical approach only then I have had luck with this protocol and recheck in 3 weeks:
Helicobacter/Gastritis protocol
A clinical trial of Zithromax (Dogs: 5-10 mg/kg p.o. q24h. May increase dosing interval to q48h after 3-5 days of treatment), Metronidazole (10-20 mg/kg po bid) , Pepcid ( 0.5-1 mg/kg sid) and Sucralfate (0.5-2 g/dog PO) or Omeprazole (1 mg/kg po sid) over the next 3 weeks along with a novel-protein or hydrolyzed diet with slurry feeding bid/tid. over the next 2-4 days and then increase to canned diet bid. Dry food should be avoided over the next 4 weeks. A recheck sonogram to assess GI improvement or progression would be ideal in 4 weeks.
Silvana if you try the
Silvana if you try the empirical protocol please post new image set after tx in 3 weeks or so.
Silvana if you try the
Silvana if you try the empirical protocol please post new image set after tx in 3 weeks or so.
Thank you for your valuable
Thank you for your valuable input.
I will for sure post the pics should this case come back for US review.
EL: I thought the loss of layering was affecting submucosa, too. But after reviewing the videos, now I agree that it doesnt. And also, that the muscularis layer appeared particularly thickened in the whole stomach, but it is regular and no signs of focal thickening, so I thoutght less likely to be malignant sign. In any case, I have another question about the LNs. I would like to be able to tell which exactly is enlarged. The biggest round one (round on sagttal and transv views) measures 0.7cm aprox lies between liver and what I thought was fundus, in the lesser curvature. How do I know if it is a gastric or the left hepatic? I think I can identify the pancreaticoduodenal LN. If there is an inflammatory process, shouldn’t I bee seing more enlarged LNs? Of course, I could have missed them. How often do we get to see these Lns? And if we see them, does it imply that there is inflammatory/infiltrative process? or they may be visible in normal circumstances? (I mean in small 2-6kg dogs- I think it should make a difference but in the literature I do not seem to find that dog size is a factor)
Im sorry about so many questions.
Thank you for your valuable
Thank you for your valuable input.
I will for sure post the pics should this case come back for US review.
EL: I thought the loss of layering was affecting submucosa, too. But after reviewing the videos, now I agree that it doesnt. And also, that the muscularis layer appeared particularly thickened in the whole stomach, but it is regular and no signs of focal thickening, so I thoutght less likely to be malignant sign. In any case, I have another question about the LNs. I would like to be able to tell which exactly is enlarged. The biggest round one (round on sagttal and transv views) measures 0.7cm aprox lies between liver and what I thought was fundus, in the lesser curvature. How do I know if it is a gastric or the left hepatic? I think I can identify the pancreaticoduodenal LN. If there is an inflammatory process, shouldn’t I bee seing more enlarged LNs? Of course, I could have missed them. How often do we get to see these Lns? And if we see them, does it imply that there is inflammatory/infiltrative process? or they may be visible in normal circumstances? (I mean in small 2-6kg dogs- I think it should make a difference but in the literature I do not seem to find that dog size is a factor)
Im sorry about so many questions.
If I see them readily I pick
If I see them readily I pick up a needle for the regional parenchyma… or the Ln itself if I have a trajectory path. This Ln looks like hepatic Ln as it hugs the portal vein but is uniformly enlarged and longer than wide and not distrorted so more likely inflammatory which fits with the mucosal changes. Any chronic vomiting dog gets hypertrophied muscularis or with this hypertrophied and echogenic remodeled mucosa. Important the submucosal layer is in tact as its made to be the inner infrastructure of the orgsn… the pillar of the wall… knock down the pillar the roof collapses:(
If I see them readily I pick
If I see them readily I pick up a needle for the regional parenchyma… or the Ln itself if I have a trajectory path. This Ln looks like hepatic Ln as it hugs the portal vein but is uniformly enlarged and longer than wide and not distrorted so more likely inflammatory which fits with the mucosal changes. Any chronic vomiting dog gets hypertrophied muscularis or with this hypertrophied and echogenic remodeled mucosa. Important the submucosal layer is in tact as its made to be the inner infrastructure of the orgsn… the pillar of the wall… knock down the pillar the roof collapses:(
Ah! Thanks! that is a very
Ah! Thanks! that is a very useful tip.
Thank you!!
Ah! Thanks! that is a very
Ah! Thanks! that is a very useful tip.
Thank you!!