Today's Veterinary Practice

MAY-JUN 2018

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63 MAY/JUNE 2018 ‚óŹ TVPJOURNAL.COM CLINICAL INSIGHTS Occasionally, a pancreas can be diffusely hyperechoic but still measure within normal limits for thickness ( FIGURES 1 AND 7 ). Histopathology in dogs with a hyperechoic pancreas has been normal to fibrotic from what was believed to be prior pancreatitis. ABNORMALITIES Pancreatitis The most common abnormality of the canine and feline pancreas is pancreatitis. Pancreatitis can have a variety of ultrasound abnormalities depending upon the severity, extent, and duration of the pancreatic and peripancreatic changes. 1 Detection of pancreatitis on ultrasound may be difficult as the pancreas can appear ultrasonographically normal. A normal appearing pancreas does not rule out pancreatitis. In acute pancreatitis, the pancreas can become enlarged, hypoechoic, and rounded or irregularly marginated. The surrounding mesenteric fat is hyperechoic and hyperattenuating, and there is often mild to moderate collections of echogenic effusion in the area of the inflamed pancreas ( FIGURE 10 ), representing peritonitis and/or fat saponification. Fat saponification is also known as steatitis. Saponification of the peripancreatic mesenteric fat may be present as a result of the release of pancreatic enzymes locally and may cause multifocal areas of dystrophic mineralization around the pancreas, forming small hyperechoic shadowing structures ( FIGURE 11 ). 1 The duodenum and/or stomach wall can be thickened due to secondary inflammation of this area. A focal paralytic ileus and corrugation of the duodenum can be present ( FIGURE 12 ). In these patients, the wall layers will be altered but there will not be total loss of wall layering as seen in neoplastic processes of the stomach and duodenum. Rarely, the colon (ascending or transverse) can be involved. FIGURE 9. Short axis (transverse) ultrasound image of the left cranial abdomen showing a long axis image of the left lobe of the pancreas in an older cat with nodular hyperplasia. Notice the irregular margins of the pancreas and the hypoechoic nodules within the pancreas. On histology, these were areas of nodular hyperplasia. PD , pancreatic duct; PV , splenic portal vein. FIGURE 10. Severe pancreatitis in a dog with a large, ill defined, hypoechoic mass ( PA ) noted in the mid to far field and surrounding irregularly marginated, hyperechoic mesentery ( ME ) consistent with fat saponification and peritonitis ( A ). On color Doppler evaluation, there was no blood flow noted in the pancreatic mass, which is consistent with necrosis. Pancreatitis in a cat with an ill defined, enlarged, anechoic pancreas ( PA ) with increased echogenicity surrounding the pancreas in the mesentery ( ME ) ( B ). This is consistent with regional peritonitis and steatitis associated with pancreatic inflammation. In the area deep to the inflamed pancreas and mesentery, there is marked attenuation of the ultrasound beam ( AT ) secondary to the severe regional steatitis. A B

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