-9 year old Boston, appears Cushingoid
-presented for large amount unexplained weight loss over the past few months
-hepatomegaly with heterogeneous echotexture and large number of bladder stones noted
-9 year old Boston, appears Cushingoid
-presented for large amount unexplained weight loss over the past few months
-hepatomegaly with heterogeneous echotexture and large number of bladder stones noted
I originally thought this mineralized structure was associated with the right adrenal but then I was pretty sure I saw the relatiely normal appearing right adrenal in several clips. Is it possible I missed it on the left side then picked it up on the left adrenal when looking at the right side? I will attach several clips so you can help me sort out what I am seeing.
Thanks for the help!
Comments
With this very distinct
With this very distinct comet-tail shadow a possiblity would be an intestinal foreign body. Consider doing radiographs of the abdomen.
I can recommend x-rays but
I can recommend x-rays but I’m not sure how likely that is. They called me to figure it out! (And now I am asking you…)
I have clips above taken in longitudinal and transverse orientations; I really did not think at the time it was intestinal and there was definitively not an obstructive pattern in the GI tract.
Are there other possibilities?
Thanks!
I am confused. I always
I am confused. I always thought that x-rays and ultrasound complement each other. Like the pieces of a puzzle- leave any piece out and you don’t see the entire picture. Any attitude short of this is hubris IMO.
I think an intestinal FB is possible here. I slowed down the 3rd cine and took a screen shot. Could this be bowel with loss of the normal “curvi-linear” pattern?
Not trying to be difficult- just another opinion.
I appreciate any other
I appreciate any other opinions and am a frequent visitor here to continue learning.
I am also not trying to be difficult and would always be happier having x-rays to go along with u/s. Just not sure they will do it.
However, if you think it looks like an intestinal foreign body, that would fit the clinical picture better. I didn’t see it as a loop of bowel but that is why I posted. I guess it would have to be a partial obstruction since there was no other dilated bowel?
Thanks again.
Questioning is not being
Questioning is not being difficult as it keeps everyone on their toes. As Randy states, radiographs do compliment ultrasound especially in cases like this. Chronic foreign body without causing an obstruction would fit the clinical and ultrasound picture.
yeh I see what you guys are
yeh I see what you guys are saying re intestinal fb and the hypoechoic ring around the mineralization but the duodenum is the only intestine that lives there and that is clearly separated far ventrally from the lesion. If you look and scroll through loop number 2 it appears that the mineralizing mass is deriving form the cranial base of the right adrenal and 70% of the caudal portion of right adrenal is normal. if USG is < 1.020 then LDDST should help confirm right adrenal adenoca but regardless needs a surgeon as it appears to be tight with the cvc but seperate fomr it. the left adrenal would be to the right on the image so that wouldnt fit. Otherwise some weird distrophic mineralized structure in the fat is possible. Check BP too in case adrenal related hypertension is present as well to support the adrenal mass theory.
CT would be ideal here. Anyone have a Vimago near you? 🙂
http://www.epicamed.com/products/vimago
smbrown- vindicated 🙂
Humbly
smbrown- vindicated 🙂
Humbly give credit where credit is due
So glad you posted that
So glad you posted that Suzanne, because I have not seen that before.
After the first couple of
After the first couple of replies, I advised the clinic this morning that foreign body was likely. I am not sure if they went in today or not. Either way, the dog needed a cystotomy too. They are general practitioners so I doubt they are comfortable removing adrenal masses (I know I’m not!)
Hopefully, they figured out what it was and I can update.
Interesting discussion.
Suzanne
Just another thought – could
Just another thought – could this be in the proximal ureter but not causing obstruction? The dog is a stone former. Please let us know the outcome Suzanne – interesting case
Interesting thought JP but if
Interesting thought JP but if you look very cloesely and follow the lines from the renal pelvis the renal vessels and right ureter are outside the mineralizing structure in the near field. This is like trying to solve a rubics cube lol:)
Unfortunately we are not
Unfortunately we are not going to know the outcome on this one. The owners decided to euthanize and took the body home for burial. I still vote on a mineralized adrenal mass but who knows.
darn… how about a post
darn… how about a post mortem US-guided Bx of the lesion? Most owners go for that if they dont have the visual of an open up post mortem. Then everyone knows what went on there especially the owner.
I would have liked to try
I would have liked to try that but I was doing the ultrasound as part of my mobile practice. I was not at the clinic when the clients made the decision and was just informed of it after the fact.