Transcript VMB 976 A Ultrasound - Nc State University

VMB 976 A Ultrasound
Laura Paasch
Case report
Haley Parrott
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10 year old FS Labrador
Presented on emergency for possible
splenic mass
Seen at rDVM 5 days previously for
abnormal urination and flatulence
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Prescribed a gastroprotectant
Seen by rDVM for vomiting
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PCV-29%
Large abdominal mass on radiographs
Initial Work-Up
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PE
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Bloodwork
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Depressed, pale mm, P-140, RR-28, T-102, CRT 4 sec
Large abdominal mass on palpation
PCV-32%, TP-6.0, BUN-30-40, GLU-47, icteric
plasma, thrombocytopenic (55,000), elevated APTT23.3 sec
Imaging
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Chest radiographs- no evidence of metastasis
Abdominal U/S
Post-Operative
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Recovery
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ICU, Fluids, Fentanyl CRI, KCl, Metoclopramide,
Lidocaine (VPC’s), Famotidine …..
Still recovering in ICU following morning
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Alert, ambulatory, drinking, not eating, fewer VPC’s,
almost moved to intermediate!
Next morning
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Severe hemorrhagic diarrhea
Hemorrhage from nares/mouth
Euthanized
Necropsy
Necropsy Report
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Multiple pulmonary and mesenteric thrombi
Liver thrombus, multifocal necrosis
Marked, diffuse hemorrhage of stomach and
intestine
Myocardial degeneration and necrosis
Splenic hematoma with areas of infarction and
marked diffuse hemorrhage
DIC
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Large amount of blood loss, platelets, clotting
factors hypercoaguability
Hypoxia, acidosis, inflammation endothelial damage
Normal Spleen
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<25mm dogs, <8mm cats
Upper left quadrant
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Tail and body along L body
wall or ventral abdomen
Echogenic capsule
Parenchyma finely textured,
homogenous
More echogenic than liver L
kidney cortex
Splenic A & V at hilus, not
abnormal to see fat
surrounding
Abnormalities
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Splenomegaly
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Anesthetics
Immune mediated
Infectious, parasites
Neoplasia
Torsion
Passive congestion
Abnormalities
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Hypoechoic
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Congestion
Infections
Infiltrative disease
Amyloidisis
EMH
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Hyperechoic
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Chronic inflammation
Vascular compromise
Peritonitis
Infections
Infiltrative disease
Fibrosis
Mineralization
Abnormalities
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Focal/Multifocal
lesions
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Nodular
hyperplasia
EMH
Abscess
Neoplasia
Necrosis
Fibrosis
Calcification
Hematoma
Hematomas
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Trauma
Clotting disorders
Neoplasia (hemangiosarcoma, lymphosarcoma)
Extreme variation in appearance
Local hemorrhage  hemoabdomen
Unclotted blood (anechoic to hypoechoic)
Clotted blood (isoechoic to hyperechoic)
FNA
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Non-diagnostic
False negatives