The full AUS
I wanted to tell you about a recent patient that made it very clear to me why when I was trained in small animal sonography, they said not to only image 1 organ and instead always do a full abdominal ultrasound. I have changed the names for the privacy of the clients. On September 15, 2023 Tawny presented to our clinic for urinary accidents in the house and a bump above her anus that has gotten a little bigger since first noticed a couple of months ago and maybe a little more red. Tawny is a 12 year old, spayed female, canine mixed breed that weighs 35.5 lbs. She and her owners are new to our clinic and Tawny hasn’t been to a vet in a few years. She is not on any medications currently and her current diet is Frontier salmon and sweet potato formula. Tawny does suffer from separation anxiety that has been getting worse as she is getting older. The plan on 9/15/23 was to r/o adenoma vs adenocarcinoma. Discussed Cushing’s disease since there is often underlying hormonal stimulation causing perianal adenomas. FNA of the perianal mass with cytology. Recommend LLDST and senior panel (esp. if the cytology came back as perianal adenoma). If cancerous, will discuss staging and prognosis upon receipt of results. Will discuss removal at that time as well. The microscopic findings from cytology came back as perianal gland tumor (hepatoid tumor). Discussed with Owner that this is a benign mass and that it is caused by excess hormones. Discussed Cushing’s testing as the next step prior to scheduling the removal of the mass. On 9/26/23 Tawny returned for LDDST and Senior panel blood work. LDDST is consistent with Cushing’s syndrome. Additionally, we detect a UTI. The rest of her organ function tests are normal. This is when we had the discussion of pituitary gland dependent Cushing’s or adrenal gland tumor. AUS is recommended currently to look for an adrenal gland tumor. It is offered to the Owner to do a targeted scan, where only the adrenal glands are imaged, or a full AUS with a consult from a specialist. On 10/19/23 Tawny returned to us for an AUS. The findings from the Specialist that read the AUS were that Tawny’s hyperadrenocorticism is most consistent with bilateral adenomas (uncommon presentation, but possible) i.e. adrenal dependent hyperadrenocorticism. However, the patient’s bladder wall changes and abnormal medial iliac lymph node, are concerning for underlying malignancy with metastatic disease. During the AUS the owner was called to discuss an enlarged LN and FNA of the LN for cytology. We started Tawny on Clavamox for the UTI and sent out the FNA for cytology of the LN. Cytology interpretation: Carcinoma with necrosis, likely metastatic/effaced LN. Discussed with client a referral to oncologist vs us consulting with tele-oncologist to discuss chemotherapy options vs palliative care.
As you can see there was a lot more to a full AUS vs a targeted scan and we could potentially be making Tawny much more comfortable and extending her life.
