2013 Radiology Exam - Ultrasound Case 2

Signalment: 7 year old, male castrated, Boston Terrier

History: Swelling of mandibular region.

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Observations:

  • Large area of hyperechoic tissue in the right submandibular (or retropharyngeal) region. Hypoechoic streaking in the subcutaneous tissues surrounds this area.
  • Centrally there are multiple ovoid or irregular hypoechoic nodules/structures.
  • There is a thin, linear, hyperechoic structure causing distal acoustic shadowing and brief reverberation artifact within one of these structures. It is surrounded by a small rim of anechoic fluid.
  • The mandibular salivary gland, ramus of the mandible, hyoid apparatus, and larynx are also imaged and are normal.

Synthesis:

  • The linear and shadowing structure is highly characteristic of a submandibular foreign body.
  • The surrounding tissue indicates cellulitis/abscessation.
  • The hypoechoic nodules represent either reactive mandibular lymphadenopathy, pockets of exudate, or a combination of the two.

Case Management:

  • Surgical exploration/drainage or ultrasound-guided foreign body removal and drainage are indicated (both acceptable)
  • Fine needle aspirate for cytology and culture prior to surgical exploration (this is an appropriate suggestion, though no points awarded for its inclusion or removed if not suggested)