Case of the week 8.10.20
Publication Date: 2020-08-10
History
9 year old female spayed mixed breed dog. Increased ALP (8000), increased total bilirubin (13)
3 images
Diagnosis
The patient has an excessive amount of subcutaneous and intra-abdominal fat. The liver is diffusely mildly enlarged, extending past the costal arch with rounded and undulant margins. Seen on the right lateral view, there are at least 2, round, soft tissue opaque structures superimposed with the ventral liver. There is caudal deviation of the gastric axis. The stomach contains a small amount of gas and homogenous fluid/soft tissue opaque material. The small intestines and colon are normal. The spleen is normal. There is a rounded soft tissue opaque mass just cranial to the right kidney on the VD view which measures 2.5 x 2.3 cm. Just caudal to this mass, there is a round, well-defined, soft tissue structure with stippled mineralization. The kidneys are normal. The urinary bladder is normal.
Discussion
- The mass cranial to the right kidney and adjacent structure with stippled mineralization is most concerning for a right adrenal mass (such as adenocarcinoma or pheochromocytoma). A mass arising from the pancreas (such as pancreatic carcinoma) is also considered.
- The soft tissue opaque structures superimposed with the liver and the enlarged and undulant appearance of the liver is concerning for hepatic nodules, which may represent metastatic disease. Alternatively, these structures may represent carcinomatosis, and the appearance of the liver may represent benign (such as nodular hyperplasia) etiologies.
- An abdominal ultrasound is recommended for further evaluation.
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