Today’s case is a 7 year old male neutered Jack Russell terrier with generalized pain, lethargy, and lymph node enlargement. Take a look and post your interpretations in the comments section.
7 year old Jack Russell Terrier
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{ 17 comments… read them below or add one }
I see a soft tissue density structure in the caudal dorsal abdomen. It is displacing the gas filled small intestine cranially, and the colon ventrally. There is decreased abdominal detail- this may be due to peritoneal effusion or secondary to the mass effect. I am unable to visualize the kidneys. Considerations for the mass effect would be renomegaly (bilateral?), splenomegaly, small intestinal mass, retroperitoneal effusion? The mass area seems large for just abdominal lymphadenopathy…
I also see this structure and the organs displacing in the side.
And I agree with some suspects like intestinal or prostate gland mass and lynphadenopathy.
But about spleen, we can see in the VD that its well delimited; I´m not sure about effusion, it doesn´t seem like.
Ps. Sorry my english, I´m brazilian so this is not my first language.
Sorry of my “spanglish”… so I’ll be brief. I think there are many soft density tissue masses. In accord with histoy and visceral desplacement they may be:
a: Sublumbar limph nodes with (or without);
b) Prostate gland compromise??;
c) Abdominal lyphadenopathy.
It seems not to be effusion and lack of abdominal detail may be due to mass effect.
Angel
I agree with decreased serosal detail->peritoneal effusion. The soft-tissue masses on the VD beside the hips don’t look like something I’ve seen before, but I can’t imagine those are abnormal– they’re pretty symmetrical bilaterally. Perhaps we’re looking end-on at leg muscles (I see the knee!), or they’re just fat deposits; I’ll have to take a look at some other rads and compare.
I see abdominal displacement of the intestines. If it weren’t for that, I’d also suggest the coiling appearance of the lungs, especially visible on the lateral but possibly also on the VD (left cranial abdomen/caudal thorax) w/ an imaginoscope, might be evidence of a linear foreign body. Given the mass effect though, I’m guessing it’s just all smooshed up.
The abdominal masses seem to be present where the spleen should be, in addition to a diffuse radio-opaque region more caudally, which could either be from effusion or a mass.
As usual, I’m having a touch time making out the gastric axis.
Erm… and by lungs I meant small bowel. How did that slip by?
About “The soft-tissue masses on the VD beside the hips don’t look like something I’ve seen before”, are inguinal enlarged limph nodes. Its radioopacity is not as it is fat.
Angel
So we’ve narrowed down the possibilities to multiple enlarged lymph nodes, including those not normally seen – like the inguinal lymph nodes and mesenteric lymph nodes. What are your differentials?
Considering my infectious disease final is tomorrow, you’d think I’d have a shot at this one…
Neorickettsia helminthoeca, a fungal infection (though not very typical, since no bone, etc involvement), ehrlichia canis, lyme, b gibsoni, lymphoma, chronic nasty disease.
…but I probably missed it anyway.
I agree with some of You. On the lateral view there is a big soft tissue mass in the middle abdomen that displaces small intestines cranio-dorsally and the colon descendens ventrally. On this projection I am not able to see the margin of retroperitoneal space that is usually very well visualized. On the dv view spleen seems to be a little enlarged, kidneys are within normal limits, prostate and urinary bladder are not prominent. I would consider two things in this situation, first one is some kind of an external prostate cyst and the second one lumbar lymph nodes enlargement. But if we take a look at the shadow of this mass I would say that it is rather fluid than solid mass. Ultrasound examination would be very essential.
Oh! And it’s rare for dogs to get it, but mycobacterium avium=inguinal involvement.
Nice list of differentials, including infectious/inflammatory and neoplastic diseases. Now we need to consider what is the most likely and give a prioritized list of differentials. What are your top 2-3?
The colonic ventral displacement as visualized in this radiography is suggestive of mesenteric, iliac and/or sublumbar lymphnodes enlargement. My first shot on a generalized lymphnodes enlargement would be a limphoma.
I agree with limphoma like fisrt option.
Ok, limphoma it’s my first option.
Another view point looking fine at LL…
If sublumbar limph nodes were affected (neoplasic)… there would be L7-S any periosteal reaction… which is not present.
Why not, therefore, to think large mass displacing intestines craneal, could be full urinary bladder and caudal mass to it a prostate cyst??
My doubt in this last case is why enlarged inguinal limph nodes?? Infection??
Right, it’s lymphoma with infectious/inflammatory disease a very distant second. Angel asked if there would be periosteal reaction with enlarged sublumbar lymph nodes. It actually depends on the cancer and it’s behavior. Something like a prostatic carcinoma or anal sac carcinoma spreads via the lymphatics which can lead to the spine and sublumbar lymph nodes. Lymphoma on the other hand, is often a systemic neoplasia with all lymph nodes affected at once, including head and neck, thorax, abdomen, and pelvis.
Thanks Allison. I forgot… would it be usefull to perform a double contrast cistography to delimitate urinary bladder and prostate limits??
I like so much of contrast radiography previous an echography… and in most instances I don’t need it.
Angel
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