When Enough is Enough: Ultrasound-Guided Ascent Into Heaven Ashley C. Barfield April 4, 2007.
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Transcript of When Enough is Enough: Ultrasound-Guided Ascent Into Heaven Ashley C. Barfield April 4, 2007.
![Page 1: When Enough is Enough: Ultrasound-Guided Ascent Into Heaven Ashley C. Barfield April 4, 2007.](https://reader035.fdocuments.in/reader035/viewer/2022062722/56649f345503460f94c50f7c/html5/thumbnails/1.jpg)
When Enough is Enough: Ultrasound-Guided Ascent Into Heaven
Ashley C. Barfield
April 4, 2007
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Winston Counterman14-year-old miniature Schnauzer
• Several months of weight loss
• Vomiting 2-3 times a day for 3 days
• Decreased energy
• Small amount of diarrhea for 3 days
• Recent diet change
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Labwork Abnormalities
CBC• Mild leukocytosis• Moderate anemia• Severe
thrombocytopenia
Chemistry• BUN = 50• ALKP = 272• AMYL = 1287• TGL = 214• ALB = 1.9
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Radiographic Abnormality
RDVM noted decreased serosal detail consistent with abdominal effusion
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The Good Stuff
Large heterogenous splenic mass and multiple heterogenous nodules
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Large heterogenous hepatic mass and multiple nodules
Liver…It’s So Good
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Kidney: Not just for breakfast anymore
Bilaterally decreased corticomedullary definition, multiple heterogenous nodules, multiple cysts, one hypoechoic nodule
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And the Badness
Grossly enlarged and heterogenous right medial iliac lymph node
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The Sauce
Large amount of echogenic peritoneal fluid, consistent with hemorrhage (accompanied by a normal pancreas); aspiration yielded fluid hemorrhagic in appearance
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Interpretation
“These findings are consistent with metastatic neoplasia.”
-- Tony Pease DVM MS
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How to Save Winston?• Aspirates of liver, spleen, kidney, lymph node
• Thoracic radiographs (additional met check)
• Transfusion and surgical resection of bleeding mass
• Surgical resection/debulking of other masses
• Chemotherapy and radiation therapy based on histopath results
• Serial imaging to monitor progress during therapy
Winston’s owner elected humane euthanasia to prevent further suffering.
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Pumpkin Rogers12 year-old spayed DSH
• 6-month history of chronic weight loss
• Watery diarrhea of unknown duration
• No change in appetite or energy level
• No PU/PD or vomiting
• FELV/FIV negative indoor cat
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Labwork Abnormalities
CBC• Mild normochromic,
normocytic anemia• Thrombocytopenia• Hypoproteinemia• Stress leukogram
(elevated SEGS & monos, decreased lymphs)
Chemistry• Hypoalbuminemia• Hypoglobulinemia• Mildly elevated ALT• Mildly elevated ALKP
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Labwork Abnormalities
Urinalysis• 1+ proteinuria• 4+ bilirubinuria
T4 = 0.53 (1-4)
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Again, the Good Stuff
Mildly thickened small and large intestinal walls
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Bowel walls also fluid-filled
Top differentials:• Neoplasia• Inflammatory
bowel disease
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Hyperechoic kidneys with decreased corticomedullary distinction
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Hypoechoic liver
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Peritoneal fluid & possible pancreatic edema
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IBD or Lymphoma?
• Full-thickness or endoscopic intestinal biopsies
• Mesenteric lymph node aspirates
• Liver and kidney aspirates
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What if it’s the big K?Met check/staging• Thoracic rads• Peripheral lymph node aspirates• Serial imaging during therapy
Prognosis• 6 months to >2 years • severity of disease (histopathologic grade and tumor
phenotype)
• response to chemotherapy
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Pumpkin’s Situation
• Loss of 50% of body mass in 6 months
• Potential involvement of liver and kidneys
• Owners elected no further diagnostics
• Owners elected pred and ice cream therapy
Pumpkin died at home the next day