Adrenals, Lymphnodes, Gall Bladder, and Pancreas Jane MacLellan.
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Transcript of Adrenals, Lymphnodes, Gall Bladder, and Pancreas Jane MacLellan.
Adrenals, Lymphnodes, Gall Bladder, and Pancreas
Jane MacLellan
Adrenal Glands
In the dog - peanut shapedIn the cat - more ovalLocated cranial and medial to kidneys
Left - caudal to the branches of the aortaRight - adjacent to caudal vena cava
Locate kidney, then fan medially with probeHypoechoic - similar to blood vessels
Can be hard to distinguish - use doppler
Overlying bowel can obscure
Adrenal Gland Disease
Measure length and widthLength with vary between animals
Proportional to body weight
Width does notWidth may increase with disease
Normal width = < 0.74 cmNote: New paper suggests dogs < 10Kg normal
width < 0.6 cm
Adrenal Gland Disease
Pituitary dependent hyperadrenocorticismBilaterally enlargedNormal shape - but ‘plump’Thickened polesUniformly hypoechoicNodular hyperplasiaNormal size does not r/o PDH
Adrenal Gland Disease
Adrenal tumorGland enlargementAbnormal shapeChange in echotextureUnilateral masses more commonCan’t distinguish benign from malignant tumors
May be able to tell if invading surrounding tissue
Lymph nodes
More sensitive then radiographsMedial iliac and jejunal lymph nodes
LargeMore often seen when normal
Normal - same echogenicity as surrounding mesentery
Easier to see in young, thin animalsWhen enlarged, more hypoechoicCan do ultrasound guided FNA
Lymph nodes
Medial iliacNear terminal portion of aorta and caudal vena
cavaNot normally seen unless enlargedBladder, prostatic neoplasia
VisceralSeen when doing routine scan
Gall BladderVisualized just right of midline in liverSize is variable - depending on last meal
Fasting or anorexia In cats, can be bi-lobedThings you might see
Thickened wall Stones Mucoceles Cholestasis Cholecystitis “Sludge” Icterus
Thickened WallWall normally thin, echogenic, poorly visualized
<1mm in cats, slightly thicker in dogDouble layered - inside and outside surfaces – Halo sign
Thickening is a non-specific signChronic hepatitisCholecystitisCholangiohepatitisRight CHFHypoalbuminemiaSepsisNeoplasia
SludgeCommonly seen
Especially if haven’t eaten recentlyDependent
Mucocele
Cystic mucinous hyperplasia
Proliferation of GB epithelium
Increased mucin production
Marked distension of the GB
Kiwi appearance
CholelithsUncommonIncidental findingShould be noted - cholecystitis or biliary obstructionHyperechoicAcoustic shadowingMobile
Bile DuctSeen as a continuation of
the GBDogs - not consistently
seenShould be < 3mm
Cats - more often seenShould be < 4mm
Ventral to portal veinExtrahepatic obstruction
Dilation of GB and bile duct
GB Artifacts
Mirror image duplicateSound wave bounces off the diaphragm, echos
off the gall bladder back towards diaphragm, reflected towards the transducer
RefractionWhen sound waves go through tissues of
different acoustic impedance
Acoustic enhancementLess attenuation compared to liver
Pancreas
Normal is routinely difficult to visualizeEchogenicity similar to surrounding fatNo defined capsule
Less echogenic then spleen, more echogenic then liver
Right limb just dorsal to duodenumMore likely to see in puppies, thin dogs, or
with free abdominal fluid
Pancreatitis
Acute - surrounded by a hyperechoic areaDue to peri-pancreatic fat necrosis
Severe - mixed echogenicityChronic - hyperechoic pancreas
Due to pancreatic fat necrosis
Pancreatic pseudocystsMass effect
Pancreas
NeoplasiaDifficult to identifyLooks similar to pancreatitis (mass effect)Fluid accumulationInvasion of surrounding tissuesEvidence of metastasis in other organs