Adrenal mass with caudal vena caval invasion, hydroureter, and uroabdomen in a 10 year old MN mixed breed dog

History

A 10-year-old MN mixed breed dog presented for renal failure from a referral hospital. In-house blood chemistry revealed hypoalbuminemia, high ALP, azotemia, hypercalcemia, and hyperphosphatemia.

A 10-year-old MN mixed breed dog presented for renal failure from a referral hospital. In-house blood chemistry revealed hypoalbuminemia, high ALP, azotemia, hypercalcemia, and hyperphosphatemia.

Clinical Differential Diagnosis

Chronic degenerative renal insufficiency, glomerulonephritis, infectious (Leptospira sp., Dirofilaria immitis, Borrelia burgdorferi), immune-mediated, pyelonephritis, neoplasia (lymphoma, renal adenocarcinoma with metastases to the surrounding organs, adrenal mass such as adenocarcinoma, adenoma, or pheochromocytoma), nephrolithiasis, ureterolithiasis, or urolithiasis causing an obstruction and secondary renal failure.

DX

Mineralizing right adrenal mass invading the caudal vena cava.

Sampling

US-guided FNA of the peritoneal fluid was found to be serohemorrhagic. Azostix revealed significant azotemia of the free fluid, suspicious for ureter rupture.

Sonographic Differential Diagnosis

Mineralizing right adrenal mass invading the caudal vena cava. Non resectable. Severe right hydroureter and mild hydronephrosis with probable uroabdomen and ureter rupture.

Image Interpretation

Both kidneys contained corticomedullary calculi. The right kidney presented significant chronic hydroureter with a ureter calculus at the mid to distal right ureter, an inflammatory adhesion pattern, and moderate pelvic dilation of 1.7cm. Free fluid was noted in the abdomen as well which was sampled and found to be serohemorrhagic. Azostix revealed significant azotemia of the free fluid, suspicious for ureter rupture. The right kidney presented moderate hydronephrosis. The left adrenal gland was normal size and contour. The right adrenal gland presented a mass which invaded the caudal vena cava. Mineralization was also present. The vena cava was nearly 80% obstructed, and is not considered resectable.

Outcome

Due to grave prognosis and surgery not being a reasonable option, owner chose to humanely euthanize patient.

Video

Patient Information

Patient Name : Ralph M
Age : 10 Years
Gender : Male, Neutered
Species : Canine
Liz Wuz Here : Yes
Status : Complete
Code : 07_00006

Blood Chemistry

  • Albumin, Low
  • Alkaline Phosphatase (SAP), High
  • Azotemia
  • Calcium, High
  • Phosphorus, High

Clinical Signs

  • Renal Failure

Images

Dilatedureter2ralphmarchamureteralmass_08082011072104

Skip to content