What about Coco?

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The duodenostomy site shows expected focal thickening, with numerous hyperechoic foci representing suture material.  The local fat is hyperechoic which is expected for a one week post-operative recheck.  There was no abnormal fluid collection near the anastomosis site.

See below a longitudinal image of the duodenostomy, between the shadows of 2 ribs, and a transverse image with numerous sutures seen best in the near wall:

But the incision of the abdominal wall appears like this:

inc 2

An elongated fluid pocket dissecting the subcutaneous tissues, and likely representing an infected seroma.

The dog was sent back to surgery for debridement of the infected incision.  The abdominal cavity was lavaged as it was suspected to be contaminated, but the duodenostomy site was confirmed to be intact.

The dog recovered uneventfully.

Time to play…

One week ago, Coco, a 3 year old mixed dog breed, had surgery for a foreign body at a referral clinic.  He was doing well but now his appetite has decreased and he is a bit lethargic.   An ultrasound was performed to rule out dehiscence…what do you think?

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And the answer for Blackie is…

Thank you all for your comments on this case!

Blackie was sent to surgery as the ultrasound showed a stick perforating the fundus of the stomach, and most of the stick was embedded in the adjacent omentum.  The inhomogeneous appearance of the omentum supports regional inflammation/infection. The omentum successfully sealed off the foreign body, which explains why the dog did not display any gastrointestinal signs.  The process was likely chronic.

Right after surgery, the heart rate returned to normal!

Please review the annotated video below:

 

Time to play!

Blackie, a 15-year-old cat was presented for severe bradyarrhythmia. An abdominal ultrasound was performed as part of the work-up for systemic disease that could cause 3d degree AV block. On blood work, there is a slight leukocytosis.  See a short video clip of the left side of the abdomen.  What is your diagnosis?  Recommendations?

and the answer is…

The video clip started by the bladder (on the left side of the abdomen as the dog is slightly rotated) that was normal.
Even for an intact male, the prostate is enlarged, highly echogenic, inhomogeneous with numerous variable size cysts. The prostate appears irregular in contour, this is especially obvious on the transverse plane. The urethra is a poorly echogenic structure barely distinguished in the prostate; an indwelling urinary catheter would help in better visualizing the urethra (if an intervention is planned). The appearance of the prostate support benign cystic hyperplasia. A concurrent prostatitis is possible.
When the operator is scanning the right caudal abdomen, a large cavitary structure (resembling the bladder)with a thin wall is seen, it contains echogenic sediment that is gravity dependent.
At the end of the clip, this fluid filled cystic structure appears to originate from the right side of the prostate; this is a paraprostatic cyst.

Initially, the dog has been placed on antibiotics by the referral veterinarian and responded well to the treatment as his clinical signs resolved. What to do next is often multifactorial. Your responses on management varied and are all good suggestions. Our choice was to recommend surgery to neuter the dog and marsupialize the large paraprostatic cyst. The option of performing a fine-needle aspirate of the paraprostatic cyst is reasonable but the wall being thin, there may be a higher chance for leakage. Additionally, the outcome of the FNA would not really affect the need for surgery.

The dog recovered uneventfully after surgery.

Thank you for sending your opinions!

Time to play again!

Lets start 2018 with the exam performed on Frankie, a 4-year-old male Pit Bull presented for straining to urinate and defecate. He was given 2 weeks of Baytril and his clinical signs resolved. He was scheduled for an internal medicine consultation and an ultrasound was performed. What is the likely diagnosis? What would you recommend?
Send along your thoughts!

 

Porcupine Quills

You all detected the numerous quills embedded in the shoulder of this dog, described very well their appearance: thin discrete, hyperechoic interfaces with an anechoic center. Despite being there for a while, we often don’t see well-defined fluid collection along these foreign bodies. It is not uncommon with porcupine quills…making them especially difficult to detect!
During surgery, 26 quills were removed from the shoulder region under ultrasound guidance. Five additional quills were removed from the thorax (sternotomy performed).
Ultrasound is very useful in detecting foreign material during surgery. Commonly, surgeons ask our assistance and even use ultrasound to confirm that no FB is left behind…

Porcupine quills or not?

Do you see porcupine quills? What would you do next?
Please send your comments!

Reply to play again…

Thank you for all your comments on this case!

Please watch again the video posted below, I added some pointers.  The liver is enlarged and hypoechoic with regional hyperechoic fat.  The GB is collapsed and has a thickened wall.  On the right side of the liver, a poorly defined mass is present and contains numerous small hyperechoic foci associated with reverberation and weak shadowing, likely representing gas.  The presence of gas could be confirmed by radiographs.  Presence of intra-parenchymal gas supports anaerobic infection.  As it seems localized, surgery is recommended.

Josie went to surgery; the abnormal right medial and lateral liver lobes were partially removed. The GB was collapsed and edematous, but intact.  The histopathological diagnosis was necro-suppurative hepatitis, multifocal to coalescing, severe with intralesional bacilli.  The liver samples also contain multifocal nodular regeneration.

Time to play again!

Josie, a 14-year-old Cairn Terrier presented for acute weakness, and vomiting.  Her liver enzymes are elevated.

Look at this video centered on her liver.  On the insert, the dog is lying on its back, and the left of the dog is on the top.

Please share your thoughts and comments.  The answer is coming soon!