-TOMY is a 3 year old, MN DSH cat presented for acute vomiting within the past 24h, referring vet wants to rule out foreign body.
-TOMY is a 3 year old, MN DSH cat presented for acute vomiting within the past 24h, referring vet wants to rule out foreign body.
-Ultrasound: there is a mildly echogenic fluid filled bicavitary structure of approx 1.5cmx 2cm and 1cm arising from ascending colon wall in its most immediate portion after ileocecocolic junction (ICCJ). The ICCJ in itself appears fairly norma in thickness and layering. I diagnosed this as a tiflitis, abscess of the colon and cecum. Draining was adviced and will probably be done tomorrow. I commented on report that underlying neoplasia cannot be ruled out (as the wall of colon appears thickeend and hypoechoic).
-Question: do you agree with findings? initially I thought it was a pancreatic abscess/pseudocyst but after identifying the ICCJ it became apparent it was not the case.
-After draining (and sending for culture and cytology), would you inject antibiotic? if so, which one? Is it contraindicated to flush with saline and then re-aspirate (of course all with the same needle, with one single puncture) and then inject antibiotic? on this subject. Ive recently had 2 different feline cases of lung abscess. One grew pseudomona aureaginosa. We needed to drain multiple times, is it again, ok to inject antibiotic after sampling for culture? and the flushing technique?
Thank you for your input.
Comments
That’s ugly round cell
That’s ugly round cell neoplasia until proven otherwise… intestine/prox colon and LN both need fna. Likely large or intermediate cell lsa with a young patient..minor potenital for colitis and aggressive lymphadenitis. Note the rounding and distorted architecture of the LN and loss of layering in the colon both of which are neoplastic criteria… an imperfect but directional set of criteria. See attached images form your first video on targets to stick 22 gauge under sedation.
Yes, I see… I thought it
Yes, I see… I thought it looked like evhogenic fluid rather than solid lymph node…
Hot neoplasia looks like
Hot neoplasia looks like fluid because neoplastic cells have higher water content than normal tissue and are, therfore, much more hypo to anechoic sonographically. Put power doppler over the node and you will likely see flow inside the structure which doesnt happen in fluid/asbcess which will pick up doppler signals only in the periphery. You can also palpate and cysts will be spongy whereas infiltrated nodes will be hard structures.
Well, I’ve reviewed my whole
Well, I’ve reviewed my whole exam just now cause I would have died of embarrassment if I didn’t put Doppler in there. So I did in various angles and it doesn’t read anything. And because of the generalized inflammation around and even on cranial abdomen I did think it was more like an abscess with some may be neoplasia underlying… In anyway I hope I can soon put a needle in there and get some more info… Thank you for you
Sometimes the doppler isnt
Sometimes the doppler isnt sensitive enough and be sure to use power doppler adjust prf and turn gain up to speckle level and back down to no speckle and there should be flow there…. but in the same amount of time or less you can just put a needle in it:)
That’s the sonopath rap song lol 🙂 “you can just put a needle in it”
Hehehe. You are quite right.
Hehehe. You are quite right. Except for the time it takes me to put the needle there. I will let you know.
Remember the sonographer with
Remember the sonographer with the best needle wins:) Quick and confident is key and try telecytology as well combining the sonorgam with the cyto… upload access available on sonopath telemed.
http://spa.sonopath.com/
So, what about the questions
So, what about the questions about abscesses in general? I’m thinking more on the other two cases I got… Any input there about flushing and abs injection?
I’ll refer to the
I’ll refer to the interventional procedures guided drainage portion here on sonopath
http://sonopath.com/resources/interventional-procedures
You can guide and drain anything that abscesses on the abdomen or chest avoiding vessels and such not to be “Captain Obvious” but same technique push the abdomen down to the abscess to minimize the distance and drain. Adding Abs (I usually use baytril or ampicillin) you can do to the prostate, pancreas, liver, omental abscesses, I did a gastric wall asbcess one time years ago that wouldnt go to surgery… but do not inject abs into the kidney as that can cause failure.