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VMB 976 A Ultrasound

VMB 976 A Ultrasound. Laura Paasch Case report. Haley Parrott. 10 year old FS Labrador Presented on emergency for possible splenic mass Seen at rDVM 5 days previously for abnormal urination and flatulence Prescribed a gastroprotectant Seen by rDVM for vomiting PCV-29%

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VMB 976 A Ultrasound

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  1. VMB 976 A Ultrasound Laura Paasch Case report

  2. Haley Parrott • 10 year old FS Labrador • Presented on emergency for possible splenic mass • Seen at rDVM 5 days previously for abnormal urination and flatulence • Prescribed a gastroprotectant • Seen by rDVM for vomiting • PCV-29% • Large abdominal mass on radiographs

  3. Initial Work-Up • PE • Depressed, pale mm, P-140, RR-28, T-102, CRT 4 sec • Large abdominal mass on palpation • Bloodwork • PCV-32%, TP-6.0, BUN-30-40, GLU-47, icteric plasma, thrombocytopenic (55,000), elevated APTT-23.3 sec • Imaging • Chest radiographs- no evidence of metastasis • Abdominal U/S

  4. Post-Operative • Recovery • ICU, Fluids, Fentanyl CRI, KCl, Metoclopramide, Lidocaine (VPC’s), Famotidine ….. • Still recovering in ICU following morning • Alert, ambulatory, drinking, not eating, fewer VPC’s, almost moved to intermediate! • Next morning • Severe hemorrhagic diarrhea • Hemorrhage from nares/mouth • Euthanized • Necropsy

  5. Necropsy Report • 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 • Large amount of blood loss, platelets, clotting factors hypercoaguability • Hypoxia, acidosis, inflammation endothelial damage

  6. Normal Spleen • <25mm dogs, <8mm cats • Upper left quadrant • 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

  7. Abnormalities • Splenomegaly • Anesthetics • Immune mediated • Infectious, parasites • Neoplasia • Torsion • Passive congestion

  8. Hypoechoic Congestion Infections Infiltrative disease Amyloidisis EMH Hyperechoic Chronic inflammation Vascular compromise Peritonitis Infections Infiltrative disease Fibrosis Mineralization Abnormalities

  9. Abnormalities • Focal/Multifocal lesions • Nodular hyperplasia • EMH • Abscess • Neoplasia • Necrosis • Fibrosis • Calcification • Hematoma

  10. Hematomas • Trauma • Clotting disorders • Neoplasia (hemangiosarcoma, lymphosarcoma) • Extreme variation in appearance • Local hemorrhage  hemoabdomen • Unclotted blood (anechoic to hypoechoic) • Clotted blood (isoechoic to hyperechoic) • FNA • Non-diagnostic • False negatives

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