Roxy the 8yr MN Spaniel presented with vague signs of lethargy. On abdominal palpation there was suspicion of a mass lesion. Biochemistry was completely unremarkable and haematology showed only a mild anaemia with signs of regeneration suggestive of either haemorrhage or haemolysis. There were no morphological changes to support haemolysis.
An abdominal ultrasound was performed. A small volume of free fluid was identified in small pockets. Abdominocentesis confirmed that the fluid was blood and had a similar PCV to that of circulating blood, indicating recent haemorrhage.
A large mass was identified in the mid abdomen which had variable echogenicity and areas of cavitation. Doppler suggested the mass was quite vascular. The origin of the mass was very difficult to determine due to its large size. Initially a splenic mass was considered but there was no obvious point of contact with the spleen on ultrasound. Multiple small hypoechoic masses were also noted in the abdomen consistent with enlarged lymph nodes.
Inflated chest radiographs were unremarkable. The owners were keen to pursue a definitive diagnosis in case surgical removal were feasible which may have allowed for palliation of what appeared to be a malignant process. Advanced imaging was performed using MRI to give more pre-surgical information regarding the origin of the mass.
MRI showed widespread peritoneal nodules on a much more dramatic scale than suggested by ultrasound and in addition identified the presence of pulmonary nodules (likely mets) which had not shown up on inflated chest radiographs. The MRI was able to tell us that the mass was most likely originating from the right adrenal gland and was inoperable.
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