Transcript Adrenals, Lymphnodes, Gall Bladder, and Pancreas

Adrenals, Lymphnodes, Gall
Bladder, and Pancreas
Jane MacLellan
Adrenal Glands
 In the dog - peanut shaped
 In the cat - more oval
 Located cranial and medial to kidneys
Left - caudal to the branches of the aorta
Right - adjacent to caudal vena cava
 Locate kidney, then fan medially with probe
 Hypoechoic - similar to blood vessels
Can be hard to distinguish - use doppler
 Overlying bowel can obscure
Adrenal Gland Disease
Measure length and width
Length with vary between animals
Proportional to body weight
Width does not
Width may increase with disease
Normal width = < 0.74 cm
Note: New paper suggests dogs < 10Kg normal
width < 0.6 cm
Adrenal Gland Disease
Pituitary dependent hyperadrenocorticism
Bilaterally enlarged
Normal shape - but ‘plump’
Thickened poles
Uniformly hypoechoic
Nodular hyperplasia
Normal size does not r/o PDH
Adrenal Gland Disease
Adrenal tumor
Gland enlargement
Abnormal shape
Change in echotexture
Unilateral masses more common
Can’t distinguish benign from malignant tumors
May be able to tell if invading surrounding tissue
Lymph nodes
 More sensitive then radiographs
 Medial iliac and jejunal lymph nodes
Large
More often seen when normal
 Normal - same echogenicity as surrounding
mesentery
 Easier to see in young, thin animals
 When enlarged, more hypoechoic
 Can do ultrasound guided FNA
Lymph nodes
Medial iliac
Near terminal portion of aorta and caudal vena
cava
Not normally seen unless enlarged
Bladder, prostatic neoplasia
Visceral
Seen when doing routine scan
Gall Bladder
 Visualized just right of midline in liver
 Size is variable - depending on last meal
 Fasting or anorexia
 In cats, can be bi-lobed
 Things you might see
 Thickened wall
 Stones
 Mucoceles
 Cholestasis
 Cholecystitis
 “Sludge”
 Icterus
Thickened Wall
 Wall normally thin, echogenic, poorly visualized
<1mm in cats, slightly thicker in dog
 Double layered - inside and outside
surfaces – Halo sign
 Thickening is a non-specific sign
Chronic hepatitis
Cholecystitis
Cholangiohepatitis
Right CHF
Hypoalbuminemia
Sepsis
Neoplasia
Sludge
 Commonly seen
Especially if haven’t eaten recently
 Dependent
Mucocele
 Cystic mucinous
hyperplasia
 Proliferation of GB
epithelium
 Increased mucin
production
 Marked distension of
the GB
 Kiwi appearance
Choleliths
 Uncommon
 Incidental finding
 Should be noted - cholecystitis or biliary obstruction
 Hyperechoic
 Acoustic shadowing
 Mobile
Bile Duct
 Seen as a continuation of
the GB
 Dogs - not consistently
seen
Should be < 3mm
 Cats - more often seen
Should be < 4mm
 Ventral to portal vein
 Extrahepatic obstruction
Dilation of GB and bile duct
GB Artifacts
Mirror image duplicate
Sound wave bounces off the diaphragm, echos
off the gall bladder back towards diaphragm,
reflected towards the transducer
Refraction
When sound waves go through tissues of
different acoustic impedance
Acoustic enhancement
Less attenuation compared to liver
Pancreas
Normal is routinely difficult to visualize
Echogenicity similar to surrounding fat
No defined capsule
Less echogenic then spleen, more
echogenic then liver
Right limb just dorsal to duodenum
More likely to see in puppies, thin dogs, or
with free abdominal fluid
Pancreatitis
Acute - surrounded by a hyperechoic area
Due to peri-pancreatic fat necrosis
Severe - mixed echogenicity
Chronic - hyperechoic pancreas
Due to pancreatic fat necrosis
Pancreatic pseudocysts
Mass effect
Pancreas
Neoplasia
Difficult to identify
Looks similar to pancreatitis (mass effect)
Fluid accumulation
Invasion of surrounding tissues
Evidence of metastasis in other organs