2008 Radiology Exam - Ultrasound Case 1

History: A 4 year old female spayed Labrador retriever presented for intermittent vomiting and diarrhea for one month duration.

Instructions for ultrasound cases:

• Don’t discuss ultrasound artifacts unless prompted.
• Describe the abnormal ultrasound observations.
• List a ranked differential diagnosis.
• Case management in this section may not be limited to other imaging modalities. Additional procedures which would assist in the final diagnosis of these cases may be more appropriate to discuss than other imaging modalities.

Observations:

• Spleen abnormal contour, two hypoechoic ill defined areas
• Small amount free abdominal fluid
• Lymph nodes- abnormal size and echogenicity-hypoechoic
• Small intestines- two areas loss of normal layers, thickened
• Reactive omentum

Synthesis:

Differential Diagnosis: 1. LSA 2. mast cell tumor 3. pythiosis 4. adenocarcinoma 5. Leiomyosarcoma. LSA- final diagnosis large cell lymphoma

Case management: FNA lymph node and intestinal mass, spleen