Today's Veterinary Practice

MAY-JUN 2018

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69 MAY/JUNE 2018 ● TVPJOURNAL.COM CLINICAL INSIGHTS Signs of malignancy of pancreatic neoplasms include lymphadenopathy and metastasis to other abdominal organs or to the mesentery and peritoneal surfaces (ie, carcinomatosis). In the case of carcinomatosis, hypoechoic nodules will be seen along the parietal and visceral peritoneal surfaces ( FIGURE 14 ). Cats with pancreatic carcinomatosis, will often present with a distended abdomen due to a significant effusion. Other tumor types that have been reported in dogs and cats include cystadenoma, metastatic carcinoma, and lymphoma. Although rare, endocrine tumors (eg, insulinoma) occur as hypoechoic nodules to masses within the pancreatic parenchyma. By the time of insulinoma diagnosis, metastasis has often already occurred, and careful examination of the regional lymph nodes and liver is necessary in these cases to identify metastatic lesions. Lymph nodes with metastases will be enlarged and hypoechoic. As with pancreatic carcinoma, insulinoma metastases may form hypoechoic or target- like lesions in the hepatic parenchyma ( FIGURE 15 ). SUMMARY A systematic examination of the pancreas based on normal anatomy is a routine part of the complete abdominal ultrasound evaluation. Common pancreatic abnormalities in the dog and cat may not be immediately apparent on ultrasonography, therefore, recheck ultrasound scans or other diagnostics may be indicated in some patients. References 1. Penninck DG, d'Anjou M. Atlas of Small Animal Ultrasonography. 2 nd ed. Ames: Wiley Blackwell; 2015. 2. Penninck DG, Zeyen U, Taeymans O, Webster CR. Ultrasonographic measurement of the pancreas and pancreatic duct in clinically normal dogs. Am J Vet Res 2013;74(3):433-437. 3. Hecht S, Penninck DG, Keating JH. Imaging findings in pancreatic neoplasia and nodular hyperplasia in 19 cats. Vet Radiol Ultrasound 2007;48(1):45-50. 4. Larson MM, Panciera DL, Ward DL, et al. Age-related changes in the ultrasound appearance of the normal feline pancreas. Vet Radiol Ultrasound 2005;46(3):138-142. 5. Etue SM, Penninck DG, Labato MA, et al. Ultrasonography of the normal feline pancreas and associated anatomical landmarks: a prospective study of 20 cats. Vet Radiol Ultrasound 2001;42(4):330-336. 6. Edwards DF, Bauer MS, Walker MA, et al. Pancreatic masses in seven dogs following acute pancreatitis. J Am Anim Hosp Assoc 1990;26(2):189-198. 7. Lamb CR. Pancreatic edema in dogs with hypoalbuminemia and portal hypertension. J Vet Intern Med 1999;13(5):498-500. 8. Lamb CR, Simpson KW, Boswood A, Matthewman LA. Ultrasonography of pancreatic neoplasia in the dog: a retrospective review of 16 cases. Vet Rec 1995;137(3):65-68. FIGURE 15. Hypoechoic, lobulated, 1.5 cm nodule ( MA ) measuring 1.7 x 2.3 cm in the body of the pancreas ( A ) with multiple target-like lesions ( white arrows ) noted on long axis throughout the liver of an older dog ( B ). On fine needle aspirates of the pancreatic and hepatic nodules, a metastatic neuroendocrine tumor consistent with an insulinoma was identified. ST , stomach. A B Elizabeth Huynh Elizabeth Huynh, DVM, is a diagnostic imaging resident and graduate student at University of Florida College of Veterinary Medicine. Her interests include ultrasonography, cross-sectional imaging, and nuclear medicine. She received her DVM from Ross University, finished her clinical year at Ohio State University, and completed a diagnostic imaging internship at Animal Specialty and Emergency Center in Los Angeles, California. Clifford R. Berry Clifford R. Berry, DVM, DACVR, is a professor of diagnostic imaging at University of Florida College of Veterinary Medicine. His research interests include cross-sectional imaging of the thorax, nuclear medicine, and biomedical applications of imaging. He received his DVM from University of Florida and completed a radiology residency at University of California–Davis.

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