April's Case of the Month

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Aortic Thrombus Formation in a Geriatric Canine

Sonographer: Kara Woody, DVM

Patient Information:

Age: 11 years Gender: Spayed Female            

Breed: Bichon Frise Species:  Canine

History

Presented for vomiting and diarrhea.  History of undiagnosed but suspected hyperadrenocorticism and cholecystectomy due to gallbladder mucocele formation.

Laboratory Findings

ALP and GGT are severely elevated.  Total Bilirubin is mildly elevated. 

Ultrasonographic Findings

  1. The liver is moderately enlarged with a rounded shape and coarse echotexture with multi-focal punctate areas of mineralization.
  2. Both adrenal glands were visualized and recognized as having abnormally rounded "plump" shape, increased/normal size (Lt/Rt = 7.0/5.4mm), normal position with stimulated overall echogenicity for this breed. 
  3. Moderate enlargement of all limbs of the pancreas having coarse heterogenous hypoechoic echogenicity and having severely hyperechoic peripancreatic fat. 
  4. A large hypoechoic structure is present within the aortic lumen (approximately 80% of the luminal diameter) which extends from the right renal artery to the aortic bifurcation. It is negative for blood flow on Doppler exam. Normal blood flow appears to flow around this structure.

Abdominal Ultrasound Interpretation

  1. Liver-the findings are moderate-DDX: chronic or acute hepatitis or cholangiohepatitis vs Steroid hepatopathy / Vacuolar hepatopathy / Glycogen storage disease / Copper storage disease vs diabetes vs neoplasia vs fungal vs toxin
  2. Adrenals-the findings are mild-moderate-DDX: bilaterally enlarged and stimulated adrenal glands are suggestive of pituitary-dependent hyperadrenocorticism.
  3. Pancreas-the findings are moderate-DDX: pancreatitis vs pancreatic neoplasia vs abscess
  4. Aorta-the findings are severe-DDX: thrombus vs neoplastic invasion (less likely)

 Comments

Pituitary dependent hyperadrenocorticism is highly suspected in this case due to clinical signs and ultrasonographic appearance of adrenal glands.  Additionally, pancreatic inflammation was present on this exam.  Both of these conditions can create a hypercoagulable state in the body.  In this patient, blood flow can be seen flowing around the large thrombus despite an almost 80% loss of lumen.  It is difficult to determine how much of the current clinical signs was due to decreased blood flow to central organs since this patient was affected by multi-system abnormalities.

Outcome

The patient was referred to a local specialty hospital for critical care management and internal medicine consult.  Due to multi-system abnormalities, the client elected palliative care with euthanasia when patient condition further declined.

 An image of the pancreas.  The peri-pancreatic fat is severely hyperechoic indicating active inflammation.

An image of the pancreas.  The peri-pancreatic fat is severely hyperechoic indicating active inflammation.

 An image of the left adrenal displaying the typical ultrasonographic appearance of pituitary dependent hyperadrenocorticism.

An image of the left adrenal displaying the typical ultrasonographic appearance of pituitary dependent hyperadrenocorticism.

 An image of the pancreas.  The peri-pancreatic fat is severely hyperechoic indicating active inflammation.

An image of the pancreas.  The peri-pancreatic fat is severely hyperechoic indicating active inflammation.

 An image of the left adrenal displaying the typical ultrasonographic appearance of pituitary dependent hyperadrenocorticism.

An image of the left adrenal displaying the typical ultrasonographic appearance of pituitary dependent hyperadrenocorticism.

Sonographer: Kara Woody, DVM

Special thanks to Coolridge Animal Hospital for allowing us to collaborate on this case.