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Pheochromocytoma In A 12-Year-Old FS Canine Mixed Breed: Our Case Of the Month August 2016

Patient Information

Age
12 Years
Gender
Female, Spayed
Species
Canine

Keywords

Exam Findings

Clinical Signs

Images

Normal right adrenal gland.
Left adrenal gland with a hyperechoic 1.03 cm nodule at the mid-cranial pole.
The left adrenal gland presented capsular expansion without capsular escape and no evidence of vascular invasion.
Eccentric mitral regurgitation.
Thickened mitral valve and tricuspid valve.
From page 122 in The Curbside Guide: "Pheochromocytoma is a tumor derived from the chromaffin cells of the adrenal medulla; it is relatively common in dogs, but quite rare in cats. These cases should be considered malignant until proven otherwise. Invasion/entrapment/compression of the caudal vena cava is common. Mural invasion or luminal narrowing of the aorta, renal vessels, adrenal vessels, and hepatic veins may also occur."

Everyone wants to find a pheo… well here is a little 1 cm pheo :) Isn’t she cute??…. but malignant. I always lecture that now that we are seeing adrenal glands every time in our SDEP ultrasound protocol it doesn’t mean that every adrenal nodule is a pheochromocytoma. Well, in this month’s case this little expansive nodule focally deviating the left adrenal capsule was, in fact, a pheo with the usual vague clinical signs on presentation. See how a pheo may present and how it may look in this month’s SonoPath case of the month imaged by Andi Parkinson, RDMS/Rachel Brilhart, RDMS of Intrapet Imaging, Baltimore, MD and interpreted by yours truly, Eric Lindquist, DMV, DABVP, Cert. IVUSS and Dr. Maggie Machen DVM, DACVIM (Cardiology) via SonoPath's telemedicine services. Case managed by Dr. L. Zakai of Frederick Road Veterinary Hospital.

History

The patient was presented for heavy breathing, panting, excessive throat clearing, weight loss. Altered CBC/Chem/UA values: BW-NSF. Radiograph Findings: chest rads-NSF.

Image Interpretation

Abdomen: The left adrenal gland presented a hyperechoic 1.03 cm nodule at the mid cranial pole. The left adrenal gland measured 2.57 cm in length. The left adrenal gland nodule presented capsular expansion without capsular escape with no evidence of vascular invasion. This appears resectable. The right adrenal gland was uniform and measured 3.07 x 0.68 cm at the caudal pole and 0.54 cm at the cranial pole.

Echocardiogram: Chronic degenerative valve disease causing moderate mitral and tricuspid regurgitation.

DX

Abdominal ultrasound revealed a left adrenal gland nodule. Otherwise, unremarkable abdomen. Echocardiogram: Chronic degenerative valve disease causing moderate mitral and tricuspid regurgitation.

Outcome

Serial blood pressure measurements +/- full adrenal panel was recommended. A recheck sonogram was recommended in 1-2 weeks to assess for any progression of the lesion. There is one portion of the adrenal gland nodule that is concerning and has focal, capsular expansion. Pheochromocytoma, adenocarcinoma and adenoma are all possible. Surgery found pheochromocytoma.

Comments

Case member search: http://www.sonopath.com/AdrenalTumor

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Videos

Left adrenal gland efficiency clip.