MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C84BEE.6C73FEE0" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C84BEE.6C73FEE0 Content-Location: file:///C:/D96412C5/PartIII_USAdrenalDisease.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Ultrasound of adrenal gland disease in the dog (and cat)

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Ultrasound findings in adrenal gland di= sease
Linda E. Luther, DVM
Diplomate ACVIM (S= mall Animal Internal Medicine)
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•Part I.  Diagnosis of adrenal glan= d disease in the dog (and cat) <= span class=3DBB style=3D'position:absolute;left:-4.36%'>•Pa= rt II.  Adrenal gland ultrasound= :  Technique and images <= /span>•Part III.<= span style=3D'mso-spacerun:yes'>  Ultrasound findings in adrenal gland disease
Outline
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Outline
•Part III.<= span style=3D'mso-spacerun:yes'>  Ultrasound findings in adrenal gland disease
–<= /span>Normal adrenal glands
–<= /span>Pituitary dependent hyperadrenocorticism (PDH)
–<= /span>Adrenal tumors (AT)
•<= /span>Cortical tumors
•<= /span>Pheochromocytomas
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Imaging technique
•See Part II:  Adrenal gland ultrasound:  Technique and image
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(and cat)
Adrenal gland ultrasound
•Animal is = in dorsal or lateral recumbancy
–This presen= tation focuses on dorsal recumbancy
•Image the adrenal glands in:
–Long-axis:=
•Sagittal plane
•Dorsal plane
–Short-axis= (not used as much)
•Measure:
–Length = ;
–Thickness (ventral/dorsal aspect)
–Width (med= ial to lateral)
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Adrenal gland ultrasound
•Ad= renal length correlates with dog’s size and age
<= span style=3D'font-weight:normal'>•Width does not
•Width/thickness tend to increase with disease •Thickness (VD plane) measurement may be the most reproducible?=
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Adrenal ultrasound:  Normal
•Normal values= =3D ?
•One study sug= gested width/thickness of 7.4 mm is normal
•Other study reported:
–Thickness ran= ge of 2-5 mm
–Width range o= f 2-14 mm
•Other study reported:
–Width of 1.9-= 12.4 mm
–<= span style=3D'mso-special-format:lastCR;display:none'>
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Adrenal ultrasound:  Normal
•Measure in both long-axis planes if possible <= /span>
–Sagittal plane:&n= bsp; Width refers to VD dimension
•Called thickness in one study
–Dorsal plane:&nbs= p; Width refers to medial to lateral dimension
•In most studies, width and thickness are not = distinguished
•When (and if) measuring in a short-axis plane, do not image in oblique plane or you = will falsely increase the size <= /div>
–<= span style=3D'font-size:86%;mso-special-format:lastCR;display:none'>
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Adrenal ultrasound:  PDH
•Used to disti= nguish PDH from AT, not to diagnose HAC
•Lots of overl= ap between normal and ‘large’
•PDH dogs may = have normal adrenals
•Not all dogs = with enlarged adrenals have adrenal disease
–<= span style=3D'mso-special-format:lastCR;display:none'>
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Adrenal ultrasound:  PDH
•<= /span>May be normal
•<= /span>Unilateral or bilateral changes:
–<= /span>Normal shape, thicker poles (one or both)
–<= /span>Abnormal shape (round or oval)
–<= /span>Nodules
–<= /span>Masses
–<= /span>May be heterogeneous
–<= /span>May be mineralized (more common with tumors)
•
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Adrenal ultrasound:  Treated PDH
<= span style=3D'font-size:88%;font-weight:normal'>•Follow up ultrasound not typically done
•Perhaps wi= th Lysodren therapy, adrenals will shrink? (not much in the literature) •One study showed post-trilostane, adrenal <= /span>= glands become larger, with more corticomedullary distinction •No studies= have looked at untreated PDH dogs over time to see if adrenals continue to grow
<= span style=3D'font-size:88%;font-weight:normal;visibility:hidden'>•
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Adrenal ultrasound:  Neoplasia
•Can’t distinguish cortical mass, pheochromocytoma, metastatic lesion,= hyperplasia (PDH) or normal tissue by ultrasound appearance alone.
•Adrenal gland= size generalizations:
–Less than 2 c= m, more likely PDH
–More than 2 c= m, more likely neoplasia
–More than 4 c= m, neoplastic
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Adrenal ultrasound:  Neoplasia
•Bi= lateral masses not as common as unilateral, but can be seen
<= span style=3D'font-weight:normal'>•Mass may involve only one pole
•Echogenicity can be homogeneous or mixed
<= span style=3D'font-weight:normal'>•Contralateral gland may be normal
•Extension into lumbar muscle might not be appreciated with ultrasound&#= 13;
<= span style=3D'font-weight:normal;visibility:hidden'>•
------=_NextPart_01C84BEE.6C73FEE0 Content-Location: file:///C:/D96412C5/PartIII_USAdrenalDisease_files/slide0061.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Ultrasound of adrenal gland disease in the dog (and cat)
Caval thrombi
•Se= en with left or right adrenal cortical tumors as well as pheochromocytomas <= span class=3DBB style=3D'position:absolute;left:-3.87%'>•Th= rombi form because of direct tumor invasion of the caudal vena cava (CV= C) = vs. the dog  being in a prothromb= otic state that may occur with HAC
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Caval thrombi
•Study* with 40 dogs with adrenal cortical <= /span>tumors and pheochromocytomas
–25% had caval thrombi
–No diff in post-op mortality (22%) if had thrombi = or not
–<= span style=3D'font-size:86%'>Invading neoplastic cells induced thrombus = formation
–<= span style=3D'font-size:86%'>Thrombi usually originated in phrenicoabdominal vein, then grew into CVC
–<= span style=3D'font-size:86%;display:none'>
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= *`Kyles AE et al. (2003) Surgical management of adrenal gland tumors with and with= out associated tumor thrombi in dogs:  40 cases (1994-2001), J Am Vet Med Assoc 223:654-662.
------=_NextPart_01C84BEE.6C73FEE0 Content-Location: file:///C:/D96412C5/PartIII_USAdrenalDisease_files/slide0057.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Ultrasound of adrenal gland disease in the dog (and cat)
Ultrasound-guided FNA/biopsy of adrenal masses
•He= morrhage, fatal hypertensive crisis are risks
<= span style=3D'font-weight:normal'>•Has been done with no complications
•May not be able to distinguish benign from malignant cortical tumors •Weigh benefit= vs. risk…will results change management of the case?
------=_NextPart_01C84BEE.6C73FEE0 Content-Location: file:///C:/D96412C5/PartIII_USAdrenalDisease_files/slide0116.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Ultrasound of adrenal gland disease in the dog (and cat)
Ultrasound images:

Normal vs. abnormal
------=_NextPart_01C84BEE.6C73FEE0 Content-Location: file:///C:/D96412C5/PartIII_USAdrenalDisease_files/slide0112.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Ultrasound of adrenal gland disease in the dog (and cat)
Normal canine left adrenal
Aorta<= /div>
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