Blastomycosis in a 2-year-old Beagle Mixed Breed: Our Case Of the Month July 2016
Neoplasia, fungal disease, benefit of the doubt for the patient, and a well placed needle. Clinically, fungal disease looks and acts like neoplasia while sonographically fungal disease looks like neoplasia … and we typically see a heck of a lot more neoplasia here in the Northeast USA as opposed to fungal disease. Buuuuuuuuut… that’s why we have a needle and know how and where to place it. This case is a typical example of that concept. Don’t give a cancer diagnosis until you have a needle that says so…. I have run into this scenario hundreds of times in my career as surely you all have at one time or another if you have been around the veterinary block for a while. But there is nothing more exemplary of diagnostic efficiency and fairness to our patients than a needle in a lesion and a cytologist that’s prepared, pragmatic and ready to read it… of course unless you can get histopath but same difference. Take a look at this Intrapet Imaging case read by SonoPath and managed by Dr. Dan Zakai of Frederick Road Veterinary Hospital- that resided in a non fungal region but came up fungal in the dx when cancer was first on everyone's differential list given the presentation. A 22 gauge needle and a couple of slides cost less than 10 cents while our choices cost a lifetime. Sonopath’s Educational Telemedicine (TM) layout provided as always in this July 2016 case of the month.
A 2-year-old FS Beagle mixed breed. Clinical findings: 2 chest nodules. Fever of unknown origin. Vomiting/diarrhea. Altered CBC/Chem/UA values: WBC 20,000. TP 8.3. BUN subnormal at 5. Globulins sl. Elevated. Coag-wnl. HWT-neg.
The gastric wall was slightly thickened in this patient. The remainder of the intestinal tract was unremarkable. The mesenteric lymph node was enlarged with distorted architecture and a pericapsular inflammatory pattern. The lymph node measured 2.15 x 1.3 cm with similar echogenicity to the lung nodules. A regional, mixed, hypoechoic area in the pancreas was also noted in this patient creating a 2.0 x 2.0 cm mass. This is likely of pancreatic origin or overlying distorted lymph node.
Thorax: The left thorax in this patient revealed a hypoechoic lung nodule that measured 1.25 x 1.09 cm. lung origin is confirmed by the peripheral air interface in the lesion.