Suspect Cushing's In An 11-Year-Old MN Boston Terrier: Our April Case of the Month 2022

Patient Information

Age

11 Years

Gender

Male, Neutered

Species

Canine

Keywords

Blood Chemistry

Images

Normal left adrenal gland.

Right adrenal gland mass.

There is no perfect test for determining Cushing's in a patient. As in most cases a series of "rule outs" are required to dial down to a diagnosis. When LDDST was inconclusive for this patient, it was time to break out the ultrasound probe. Animal Sounds Northwest's Jennavieve Walsh, CVT and SDEP® certified clinical sonographer captured the beautifully diagnostic images for this case. Detailed image interpretation by Eric Lindquist, DMV, DABVP (Canine & Feline), Cert. IVUSS.

History

Patient presents for suspicion of possible Cushing's. LDDST did not support a diagnosis of Cushing’s, however the chemistry panel does have generalized increased liver values; all considered mild-mod. ALT, AST, ALKP all mildly increased. Mild thrombocytosis - likely excitement. SDMA mildly increased. BUN/Crea normal. Abdominal ultrasound was recommended.

Image Interpretation

The left adrenal gland was visualized and recognized as having normal shape, size, position and echogenicity for this breed. The phrenic vasculature, glandular echogenicity and detail were unremarkable. Capsule, cortex, and medullary definition were normal for this age patient. The left adrenal gland measured 2.58 x 0.46 cm at the caudal pole and 0.51 cm at the cranial pole. The right adrenal gland had a disrupted curvilinear pattern with microcystic changes. The right adrenal gland measured 3.1 x 2.02 cm at the cranial pole and 1.14 cm at the caudal pole. Capsular expansion was noted. The right adrenal gland was moderately vascular. The right adrenal gland impinges upon the vena cava without obvious invasion. Minor invasion into the phrenic cannot be ruled out. The right adrenal gland appears potentially resectable. The vena cava prior to and after the adrenal gland did not appear invaded.

DX

Right adrenal mass with possible early phrenic +/- caval invasion. No obvious large invasion, appears potentially resectable.

Outcome

Surgical consult is recommended. This is likely carcinoma given the patient’s history. Further adrenal work-up is warranted including Urine cortisol to creatinine ratio is recommended.

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