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Lymphatic Obstruction

Patient Information

Age
7 Years
Gender
Male, Neutered
Species
Canine

Images

The bone appeared normal without lytic lesions. An 8.5 x 5.5 cm, mixed echogenic abscess was present,
which was drained by ultrasound-guided procedure and the distance from the skin to the abscess was measure for eventual surgical planning should a drain placement be necessary.
US-guided 22-gauge FNA of the parenchymal portion of the mass performed.

History

Sonograms aren't just for the belly and chest. If we don't know what it is, we put a probe on it, sample it, treat it, and put it on a slide. See this poor Labrador with an impressive swelling in the hind limb of unknown origin in the May, 2013 SonoPath case of the month. That's why we have a probe, a needle, and diagnostic efficiency at SonoPath.com.

Sonogram (Pancreas): Gunner (Name changed to protect the innocent :)

History: A 7-year-old MN Labrador Retriever was presented for severe hind limb swelling, bruising in the inguinal region and grade 3 limp. Mild fever was present. Radiographs revealed severe soft tissue swelling of around the femur without bone involvement. Thoracic and abdominal radiographs were unremarkable.

Clinical Differential Diagnosis

Lymphatic obstruction (lymph node/lymph vessel) – neoplasia (lymphoma, mast cell), trauma, cellulitis, granulomas, abscessation. Vasculitis. Caudal vena cava obstruction – thrombosis, neoplasia, granuloma

Image Interpretation

The hind leg was imaged and found to have mixed hypoechoic and complex proliferative tissue throughout the musculature adjacent to the right femur.

Sonographic Differential Diagnosis

Abnormal proliferative tissue in the left hind limb with abscessation. Suspect mast cell disease, sarcoma or other neoplasia or non-visible foreign body and abscess.

Sampling

US-guided FNA and abscess drainage under sedation: Cytology revealed spindle cell neoplasia and sterile suppurative inflammation.

Comments

The patient demonstrated less pain response after drainage of the abscess. Antibiotics and pain management were initiated Immediate amputation of the left hind limb is recommended with oncologist consultation. Guarded prognosis.

Videos

US-guided 22-gauge FNA of the parenchymal portion of the mass performed.
The now drained abscess cavity was then infiltrated with Enrofloxacin guided by ultrasound in case of sepsis.
Regional iliac lymphadenopathy was present, yet uniform. The remainder of the abdomen was unremarkable. There was no evidence of pathology or metastatic lesions.