This week’s KCC was about practicing interpreting an ultrasound video. It’s part of the oral exam, and it can be very disconcerting to watch someone else “drive”. There’s always something you want to see that they keep moving past! But it’s good practice to do the interpretations to orient yourself, describe what you see, and put it together with the history to make your interpretation.
Case 1
13 year old Siamese cat with lethargy. This scan started at the liver, which was enlarged and hypoechoic. The gall bladder was moderately distended, as was the common bile duct. The CBD was tortuous and looped back on itself before joining the duodenal papilla. There was no obvious mass at the papilla. The pancreas was mildly enlarged and hypoechoic but did not appear inflamed. The pancreatic duct was also enlarged. The diagnosis was chronic partial obstruction of the common bile duct, and differentials included inflammatory disease, neoplasia or calculus. The liver and pancreatic changes suggested chronic inflammation as is common in this group of diseases in cats. One year later, the changes looked similar, so inflammatory disease was the most likely diagnosis.
Case 2
11 year old Golden Retriever who had a red eye for two weeks and now has a painful eye. The ultrasound scanned through the globe. The anterior chamber and lens were identified. The vitreous body contained a hyperechoic, round mass that appeared to have strands connecting it to the iris and also touched the choroid at the back of the globe. The retina was not visible and the vitreous was clear. The most likely differential was neoplasia, since the vitreous was anechoic and showed no evidence of inflammation. Possible origins of the mass were the iris (melanoma) and the choroid. Diagnosis: melanoma originating from the iris.
Case 3
7 year old bull terrier with a mass on the neck. Orientation was difficult in this case. The scan appeared to be from lateral, with the mandibular salivary gland visible with a spleen-like echotexture in the cranial portion of the image. Caudal to the gland, there was a thin-walled, fluid-filled structure. The fluid was echogenic and the cystic area had complex septations. There were several small calculi in the far field that produced acoustic shadowing. There was a duct leading from the salivary gland into the cyst and it contained a calculus. Diagnosis: sialocele with sialoliths.
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