Sonopath Forum

Vomitng Blood

Indy was a 13 1/2 year old Keeshound with a 2 1/2 week history of vomiting. More recently vomiting blood. Generalized changes in the lungs with severe tachypnea and cyanosis. I did an ultraound of the abdomen. I was wondering if I could get your opinion on the the changes seen in and around the stomach. I am concerned about a shadowing FB/neoplasia with perigastric mesenteric changes. The lab work was essentially normal. I am posting a few of the representative cines and .jpg images including 2 chest films

The owners decided to euthanize Indy due to his poor prognosis.

I would appreciate any feedback.

Thanks

Comments

rlobetti

October 26, 2015 at 2:27 pm -

Gastric wall is thickened,

Gastric wall is thickened, irregular with loss of normal layer – fits with neoplasia. With the hyperechoic appearance of the perigastric mesentery perforation with focal peritonitis is likley. With the pulmonary congestion with air bronchograms think of edema (ARDS), metastatic disease, pneumonia.

randyhermandvm

October 26, 2015 at 3:57 pm -

Thanks Robetti. Do you think

Thanks Robetti. Do you think the shadowing on the one .jpg is gas or do you think there is a FB shadowing. The othere .jpg appears to have a mass- is that just gastric content I am seeing?

I saw the irregularity in the gastric wall too.

October 26, 2015 at 4:29 pm -

the gastric wall loses mural

the gastric wall loses mural layering which meets neoplastic criteria but chronic complicated gastritis can do this as well so needs histopath. If neoplasia then carcinoma then lymphoma would be highest on my list with the echogenic pattern. The shadowing structure is about 1.5-2cm… meds do this like sucralfate and then gradually dissolve and shadow less. Check the oral med history as sucralfate in gastric pathology that isnt secreting properly will take time to dissolve if it does at all. Ive documented a carafate in a gastritis dog that was defecated in tact 3 days post tx and once he started eating. Plus this structure unless toxic is likely not a player as its free floating and not embedded in the pylorus where it would obstruct.

Aspiration pneumonia in right lung form gastric reflux? I wouldn’t drop the C word heavy on this til you have a needle that says neoplasia. FNA the right medial lung and culture as well may just be pneumonia and a really bad gastritis especially if NSAID history.

Cool image set!

Electrocute

October 26, 2015 at 6:13 pm -

Hi Randy,
Your case reminds

Hi Randy,

Your case reminds me of one I scanned a few years back for another vet. It was a chronic GI FB that crashed and died after the scan. I thought perhaps he had perforated and died from sepsis, but the necropsy showed aspiration pneumonia and heart failure. There was no GI neoplasia in my case, but, I will always have aspiration pneumonia and heart failure on the list when scanning a tachypneic, vomiting dog.

-M

randyhermandvm

October 26, 2015 at 9:33 pm -

Thanks everyone for your

Thanks everyone for your input. Unfortunately, Indy is no longer with us to verify his pathology.

October 26, 2015 at 9:35 pm -