Ultrasound Ultrasound Case PresentationCase PresentationHollie SchrammHollie Schramm

Block 17Block 17

Signalment and HistorySignalment and History

Nero-presented on 12-19-06Nero-presented on 12-19-06 8 year old, Male, Belgian Malinois 8 year old, Male, Belgian Malinois

police dogpolice dog 2 month history of intermittent 2 month history of intermittent

diarrhea, intermittent straining to diarrhea, intermittent straining to defecate, weight lossdefecate, weight loss

When diarrhea resolves he develops When diarrhea resolves he develops a thin ribbonlike form to his stoola thin ribbonlike form to his stool

Physical ExaminationPhysical Examination

On abdominal palpation- mass effect On abdominal palpation- mass effect is palpable in the caudal abdomenis palpable in the caudal abdomen

Tail carriage is droppedTail carriage is dropped Extremely painful near rectumExtremely painful near rectum Palpable enlargement (bilaterally) on Palpable enlargement (bilaterally) on

rectal examination (sedated)rectal examination (sedated) Other other parameters were WNLOther other parameters were WNL Peripheral lymph nodes are WNLPeripheral lymph nodes are WNL

Diagnostic AbnormalitiesDiagnostic Abnormalities

CBC- mild CBC- mild monocytosis, monocytosis, moderate eosinophiliamoderate eosinophilia

Chemistry- elevated Chemistry- elevated Amylase and LipaseAmylase and Lipase

U/A (catheterization)U/A (catheterization)

-urine color: gold-urine color: gold

-urine turbidity: opaque-urine turbidity: opaque

-proteinuria (3+)-proteinuria (3+)

-bilirubinuria (4+)-bilirubinuria (4+)

-hematuria (3+)-hematuria (3+)

-specific gravity and pH -specific gravity and pH are normalare normal

-clumped epithelial cells -clumped epithelial cells presentpresent

Ultrasound on 12/19Ultrasound on 12/19

Ultrasound on 12/19Ultrasound on 12/19

Ultrasound on 12/19Ultrasound on 12/19

Any mets?Any mets?

Where would you look for a Where would you look for a lesion (metastisis)?lesion (metastisis)?

Ultrasound Ultrasound

Prostatomegaly- the gland contains Prostatomegaly- the gland contains diffuse anechioc cyst and occasional diffuse anechioc cyst and occasional mineral focimineral foci

Bilateral medial iliac lymphomegaly; Bilateral medial iliac lymphomegaly; rule out metastatic disease rule out metastatic disease

Mild hypogastric lymphomegalyMild hypogastric lymphomegaly

Differential DiagnosesDifferential Diagnoses

Benign Prostatic Hyperplasia and/or Benign Prostatic Hyperplasia and/or prostatic adenocarcinomaprostatic adenocarcinoma

Treatment and PlanTreatment and Plan

Nero had a reaction following Nero had a reaction following propofol sedation (for propofol sedation (for catheterization) and had a very catheterization) and had a very rough recoveryrough recovery

He was sent home on antibiotics (as He was sent home on antibiotics (as prescribed by rDVM) and pain prescribed by rDVM) and pain medicationsmedications

Recommendations: castrationRecommendations: castration

Re-evaluation on 1/22/07Re-evaluation on 1/22/07

Post-castrationPost-castration Physical examination:Physical examination:

-caudal abdominal mass effect still -caudal abdominal mass effect still presentpresent

-painful on rectal palpation (under -painful on rectal palpation (under sedation)sedation)

-firm prostate is noted, especially on the -firm prostate is noted, especially on the right side (possible anal sac, lymph right side (possible anal sac, lymph node, ect)node, ect)

Prostate at re-checkProstate at re-check

ProstateProstate

ProstateProstate

Right Medial Iliac Lymph Right Medial Iliac Lymph NodeNode

Enlarge right and left Enlarge right and left adrenalsadrenals

Nodule in the SpleenNodule in the Spleen

Nodule in the SpleenNodule in the Spleen

UltrasoundUltrasound ProstatomegalyProstatomegaly Hypoechoic splenic nodules; possible benign Hypoechoic splenic nodules; possible benign

nodules (hyperplasia or extramedullary nodules (hyperplasia or extramedullary hematopoiesis) or neoplasia. hematopoiesis) or neoplasia.

Bilateral anal gland degenerative Bilateral anal gland degenerative change, abscess or neoplasia change, abscess or neoplasia

Hypogastric and right medial iliac lymphomegaly; Hypogastric and right medial iliac lymphomegaly; reactive nodes or metastatic disease. reactive nodes or metastatic disease.

Bilateral adrenomegaly; rule out pituitary Bilateral adrenomegaly; rule out pituitary dependent hyperadrenocorticism  dependent hyperadrenocorticism 

Bilateral degenerative renal changesBilateral degenerative renal changes Hyperechoic hepatic nodule; possible Hyperechoic hepatic nodule; possible

regenerative nodule regenerative nodule

AssessmentAssessment

No change in the size of the prostateNo change in the size of the prostate Medial Iliac is still enlarged Medial Iliac is still enlarged

(especially on the right side)(especially on the right side) Since Nero was neutered and there Since Nero was neutered and there

has been hormone deprivation with has been hormone deprivation with no response it is likely that he has a no response it is likely that he has a prostate carcinomaprostate carcinoma

Assessment continuedAssessment continued

A carcinoma can only be definitively A carcinoma can only be definitively diagnosed with a tru-cut biopsy of the diagnosed with a tru-cut biopsy of the prostate (requiring general anesthesia)prostate (requiring general anesthesia)

Suggested that he receive palliative Suggested that he receive palliative radiation therapy (two daily treatments for radiation therapy (two daily treatments for two consecutive days with repeat therapy two consecutive days with repeat therapy in one month) and/or give an NSAID to in one month) and/or give an NSAID to relieve pain and inflammationrelieve pain and inflammation

Recommend monthly re-evaluation and Recommend monthly re-evaluation and ultrasounds every 2 months ultrasounds every 2 months