Thoracic Lung Mass Vs. Thymoma In An 11.5-Year-Old MN Shar Pei Mixed Breed: Our Case Of the Month June 2017
SDEP-certified clinical sonographer Amanda Lacey of Animal Sounds NW demonstrates that a mediastinal mass by any other name...is still a mass that needs a needle. In this case the mass was easily visualized, it was confirmed that the area to FNA was avascular, a clear distance from the heart, and achieved intercostally, just as one would a liver FNA.
An 11.5-year-old, 67.5 lb, MN, Shar Pei mixed breed dog was presented for chronic nasal discharge that was unresponsive to doxycycline and getting slowly worse. He started having mild congestion 3 months prior. He had enlarged submandibular lymph nodes then, which have since resolved. Hx of chronic conjunctival chemosis and elevated third eyelids. Medications: None. Radiograph Findings: Mass effect in left side cranial thorax. CBC/chem/T4/UA were unremarkable.
Left thorax in this patient reveals a lung consolidation with air entrapment. Regional inflammatory pattern is noted. The mass impinges upon the right atrium and pericardium. The mass appears to envelop the aorta rendering resection difficult; however, debulking effort may prove somewhat fruitful depending upon cytology results. Minor potential for thymoma since it appears that air is present within the mass itself which would suggest origin. Minor mitral valve thickening was noted. Normal echocardiogram otherwise.
Sonographic Differential Diagnosis
Many thanks to Amanda Lacey of Animal Sounds Northwest for her stellar imaging and FNA skills on this patient.
For SonoPath community members looking for help with thoracic FNA click here: http://sonopath.com/resources/interventional-procedures/lindquist-compression-technique-thoracic-fna