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Left adrenal mass in a 13 year old FS Shih Tzu dog

History

A 13-year-old FS Shih Tzu dog was presented for a growth on the right flank and increased appetite. Previous echocardiography had shown mild mitral regurgitation, and mild but compensated tricuspid valve regurgitation. Abnormalities on physical examination were a growth on the right flank, a growth on the right eye, and generalized alopecia. No abnormalities were seen on urinalysis, and urine culture yielded no growth. Urine Cortisol/ Creatinine ratio and LDDS test results were elevated, CTSH results were high, and T-4 and free T-4 were within normal range. 

A 13-year-old FS Shih Tzu dog was presented for a growth on the right flank and increased appetite. Previous echocardiography had shown mild mitral regurgitation, and mild but compensated tricuspid valve regurgitation. Abnormalities on physical examination were a growth on the right flank, a growth on the right eye, and generalized alopecia. No abnormalities were seen on urinalysis, and urine culture yielded no growth. Urine Cortisol/ Creatinine ratio and LDDS test results were elevated, CTSH results were high, and T-4 and free T-4 were within normal range. 

Clinical Differential Diagnosis

Adrenal gland neoplasia/hyperplasia resulting in Cushing’s disease.

DX

Left adrenal mass

Sampling

US-guided Tru-cut biopsies of the left adrenal gland and a mesenteric lymph node revealed normal appearing adrenal tissue and lymphoid proliferation.

Sonographic Differential Diagnosis

Left-sided adrenal gland mass. Cranial mesenteric lymphadenopathy.

Image Interpretation

There was a left adrenal gland mass that approached 2 cm in diameter. It appears to have a relatively uniform, rounded shape. However, there were some areas of the gland where the capsule was irregular.

Outcome

Due to concern regarding caudal vena cava invasion on the ultrasound, a CT scan was suggested for definitive assessment. The patient was treated with Trilostane. ACTH stimulation results were pre 2.1 and post 3.8. A follow-up ultrasound several days later showed no change. The patient was presented for difficulty breathing, decreased appetite, and decreased drinking. Physical examination found the patient QAR, pink mucous membranes with CRT<2, a grade V/VI systolic murmur with precardial thrill, and increased submandibular lymph nodes. The patient was treated with Clavamox and placed on low dose aspirin therapy for life.

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Patient Information

Patient Name : Gizmo S
Age : 13 Years
Gender : Female, Spayed
Species : Canine
Liz Wuz Here : Yes
Status : Complete
Code : 07_00072

Clinical Signs

  • Cutaneous mass
  • Polyphagia

History

  • Mitral insufficiency
  • Tricuspid insufficiency

Exam Finding

  • Alopecia
  • Masses

Special Testing

  • LDDST Positive for Cushing’s

Urinalysi

  • Culture negative
  • Urine Cortisol/Creatinine, High

Images

Adrenalmass_07012012010948

sonoadmin-KV 2018
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