Left Adrenal Mass in a 16yr old, MN, Havanese
A 16-year-old MN Havenese with a history of an adrenal tumor was presented for evaluation of chronic intermittent vomiting for the past 4 weeks. Current therapy was Lysodren, famotidine, carafate, enalapril, amlodipine, and tramadol 50mg ¼ BID.
Clinical Differential Diagnosis
The urinary bladder, trigone, and pelvic urethra presented normal thicknesses and normal tone. The ureters were not visible which is normal. Bladder stones were noted. No evidence of inflammatory or neoplastic changes was noted. Ureteral papillae were normal.
The left kidney measured 4.4 cm with multiple calculi, cyst , moderate degenerative changes and infarct. The right kidney was uniform and measured 4.47 cm.
The left adrenal gland mass now measured 4.8 x 3.2 cm and was irregular in contour. The tumor now invaded the vena cava to an extent of 4.3 cm of dilation of the vena cava. The right adrenal was uniform and measured 1.72 x 0.57 cm cranial pole and 0.63 cm at the caudal pole.
The base and limbs of the pancreas were observed to be largely isoechoic to surrounding omental fat. Some parenchymal remodeling, however, with mild deviation from curvilinear normalcy was observed. Pancreatic duct and capsular irregularities were present consistent with age related changes. If pain upon imaging (+ Murphy sign) was present or if the patient is focally painful in subxiphoid palpation then low-grade smoldering chronic pancreatitis should be suspected.