Today's Veterinary Practice

MAY-JUN 2018

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67 MAY/JUNE 2018 ‚óŹ TVPJOURNAL.COM CLINICAL INSIGHTS In the case of chronic pancreatitis, the pancreas can be hyperechoic or heterogeneous (hyper- and hypoechoic areas) and thickened with peripancreatic inflammatory changes. One can see pancreatic ductal dilation in cats with chronic pancreatitis, although as mentioned above, age-related dilation is commonly seen in older cats. Noninflammatory Pancreatic Edema In dogs and cats with hypoalbuminemia or portal hypertension, edema of the pancreas can be present. Edema fluid in the interlobular septae of the pancreas appears ultrasonographically as multiple anechoic areas that divide the gland, resulting in a distinctive tiger-stripe appearance. 7 Pancreatic Neoplasia It may be difficult to differentiate pancreatic neoplasia from abscesses, necrosis, and acute pancreatitis. Pancreatic neoplasia can arise from either the exocrine (eg, adenocarcinoma) or endocrine (eg, beta cell tumors or insulinomas) portion. 8 Differentiation between pancreatic neoplasia and nodular hyperplasia may be difficult as they have similar ultrasonographic findings. However, a single lesion exceeding 2 cm in diameter is more likely to be neoplastic, whereas nodular hyperplasia typically forms multiple, smaller hypoechoic nodules. 1 Adenocarcinomas form hypoechoic or heterogeneous pancreatic masses without evidence of peripancreatic inflammation. These tumors have been shown to develop within the body of the pancreas; they can compress the bile duct, invade adjacent gastrointestinal structures, and have frequent metastases to the liver (there the nodules may be target-like in appearance, with a hypoechoic rim and iso- to hyperechoic center). The mass(es) may have dystrophic mineralization associated with the tumor. FIGURE 13. Pancreatitis resulting in an extrahepatic biliary duct obstruction in a dog. The bile duct ( BD ) is abnormally dilated secondary to inflammation of the pancreas at the level of the entrance of the bile duct into the major duodenal papilla (not shown in this image). There is marked enlargement of the right lobe of the pancreas with a mass effect ( MA ) relative to the body of the pancreas ( PA ). Pancreatic duct dilation ( PD ) is also noted. FIGURE 14. Pancreatic hypoechoic mass ( MA ) that measures 2 x 4 cm in a cat diagnosed on fine needle aspirate with pancreatic adenocarcinoma ( A ). Multiple hypoechoic nodules ( No ) are present throughout the mesentery ( ME , visceral peritoneal) surfaces ( B ). A small amount of peritoneal effusion is present ( EF ) in this image. A B Patients with pancreatitis often have significant cranial abdominal pain and resist the pressure of the transducer that is necessary to image the region. Therefore, appropriate sedation and analgesics should be considered to improve image quality and diagnostic accuracy.

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