November's Case of the Month

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Sonographic Findings of a Right Adrenal Mass and Saddle Thrombi in a 9 Year-Old Pit Bull

Sonographer: Tyler Anderson DVM

Patient Information:


Age:
9 years

Gender: Spayed Female

Species: Canine

History

PU/PD with a recent onset of diabetes mellitus. Low-dose dexamethasone results reveal no suppression at 4 and 8 hours post-injection.  Patient has severe hind-limb paresis and is unable to stand.  

Image Interpretation


Abdominal sonographic findings reveal a moderately to severely enlarged liver having multifocal nodules throughout the parenchyma; A suppressed, mildly isoechoic and flattened left adrenal gland (LtCr/Cd = 3.4/3.3mm).  The right adrenal gland is severely enlarged (RtCr/Cd = 21.1/23.2mm), hypoechoic, and infringes upon the phrenicoabdominal vein and caudal vena cava.  Thrombi are noted at the bifurcation of the aorta and caudal vena cava and extends into the internal and external iliacs.  Reduced blood flow is noted on color doppler.  

Diagnosis and Sonographic Analysis:


Differentials for an adrenal mass include cortical neoplasia: 

Adrenal adenocarcinoma


Benign changes such as a non-functional adenoma vs. myelolipoma vs. hyperplasia 


Medullary neoplasia: 

Pheochromocytoma (rare); And a functional adenoma.  

Case Outcome

Unfortunately the animal was humanely euthanized due to the severity of the patient’s symptoms and sonographic findings.

 The left adrenal gland has a “suppressed” appearance. It is flattened with relatively reduced thickening to both the cranial and caudal poles and having a mildly isoechoic echogencity.

The left adrenal gland has a “suppressed” appearance. It is flattened with relatively reduced thickening to both the cranial and caudal poles and having a mildly isoechoic echogencity.

 The right adrenal gland is mass-like and severely enlarged compared to the left adrenal gland. Note that that right adrenal is more hypoechoic in nature compared to the mildly isoechoic nature of the left adrenal. Iosechoic adrenals are typically observed when suppressed by a contralateral adrenal mass, corticosteroid use, and Addison’s disease.

The right adrenal gland is mass-like and severely enlarged compared to the left adrenal gland. Note that that right adrenal is more hypoechoic in nature compared to the mildly isoechoic nature of the left adrenal. Iosechoic adrenals are typically observed when suppressed by a contralateral adrenal mass, corticosteroid use, and Addison’s disease.

 A large thrombus is noted in the caudal vena cava. Reduced blood flow is noted (center of image) on doppler as the thrombus extends into the iliacs, as seen below.

A large thrombus is noted in the caudal vena cava. Reduced blood flow is noted (center of image) on doppler as the thrombus extends into the iliacs, as seen below.

Special Thanks to Holistic Veterinary Healing for the case and follow-up information.