Ch. 39- Peritoneal Space

Question 1

What is your ultrasonographic findings?

Answer 1

Hypoechoic pancreas

hyperechoic sorrounding mesentery

Question 2

Medial iliac lymph nodes are previously know as what?

Answer 2

external iliac lymph nodes

Question 3

What do the visceral LNs drain?

What are some examples?

Answer 3

liver, spleen, intestines, pancreas, stomach

cranial mesenteric lymph center: jejunal and colic LNs

Question 4

Describe your findings and the most likely ddx

Answer 4

Ill-defined miliary (nodular, mottled, granular) pattern is appreciated in the cranioventral peritoneal cavity.

Most likely ddx: carcinomatosis

Question 5

Location of medial iliac LNs

Answer 5

ventral to L5-L6, however these LN often are located ventral to L6-L7

Question 6

What is the echogenicity of adrenal glands in u/s?

Answer 6

Both adrenal glands of dogs and cats are hypoechoic
to the surrounding fat and hypoechoic or isoechoic when
compared with the renal cortex.

Question 7

Explain how both adrenals are found when doing an abd u/s

Answer 7

Find cranial pole of the left kidney in a saggital plane, slide medially to the aorta. The left adrenal gland lies just ventrolateral to the aorta between the cranial mesenteric and renal arteries. Occasionally, the left adrenal gland may be located slightly cranial to the celiac and cranial mesenteric arteries. Usually is peanut shaped.

Find cranial pole of the right kidney in a saggital plane, slide medially to the caudal vena cava. The right adrenal gland lies dorsolateral to the caudal vena cava and cranial to the renal vein. Usually is comma shaped or bent-arrow shaped

Question 8

What are the components of connecting peritoneum?

Answer 8

Splenorenal ligament

Gastrosplenic ligament

Falciform ligament

Omentum

Question 9

What are the measurements of normal adrenal glands in u/s

Answer 9

The normal adrenal gland
has been reported from 0.91 to 5.02 cm in length, from 0.19
to 1.74 cm in width and from 0.17 to 1.07 cm in thick
ness. Depends on the size and age of the dog as well.

Question 10

Radiographic findings and diagnosis

Answer 10

Rupture of the abdominal wall

Question 11

Radiographic findings and diagnosis?

Answer 11

Tubular structures present in the inguinal area consistent with inguinal hernia

Question 12

What is your dx?

Answer 12

Hyperechoic nodule in the cranial pole of the adrenal gland

Question 13

Peritoneal effusion or not?

Answer 13

Yes

Question 14

What is the ill-defined soft tissue opacitiy(ies) that the black arrows are pointing?

Answer 14

End-on projections of the deep circumflex arteries

Question 15

Ddx for retroperitoneal fluid

Answer 15

Hemorrhage

Urine

Question 16

What are the ultrasonographic signs of pancreatitis?

Answer 16

enlarged pancreas

hypoechoic pancreas

hyperechogenicity of sorrounding mesentery

possible cavitary lesions within the pancreas

possible dilation of the CBD

possible peritoneal fluid (pancreatitis can cause peritonitis hence decreased serosal marigination)

***pancreas may appear normal***

Question 17

What is abnormal in this radiograph?

Answer 17

Medial iliac LN enlargment

Question 18

True or False: Normal Lns are normally seen on radiographs.

Answer 18

False. DUH!

Question 19

What could this mineral opacity in the mid ventral abd represent?

Answer 19

Dystrophic calcification of necrotic mesenteric fat, also known as Bates bodies

Question 20

Where are the parietal lymph nodes located?

Answer 20

retroperitoneal space (lumbar, iliosacral- iliofemoral is not located in the retroperitoneal space)

Question 21

What’s you dx?

What projection is this?

Answer 21

Pneumoperitoneum

Horizontal beam

Question 22

What is the structure that the black arrow is pointing at?

Answer 22

Left limb of the pancreas in an obese cat

Question 23

Most common bening primary tumor of the abdominal wall

Answer 23

lipoma

**** Fibrosacoma can occur in the abdominal wall of cats*** TCC might spread to the abdominal wall secondary to percutaneous tissue sampling or sx

Question 24

What are you radiographic findings and dx?

Answer 24

There is a large mineralized mass caudal to the stomach just to the right of midline. Malignant functional adenocortical tumor.

Question 25

The components of the peritoneum are:

Answer 25

Liver, Gallbladder, Stomach, Small and large intestines, Pancreas, Ovaries

Question 26

Describe your findings. What is your diagnosis?

Answer 26

There is evidence of free gas in the retroperitoneal space and double population of small intestinal loops. (need more views to determine the bowel loop that is dilated)

Pneumoperitoneum

Question 27

Components of abdominal wall

Answer 27

External oblique abdominis

Internal oblique abdominis

Transverse abdominis

Question 28

What is your diagnosis?

Answer 28

Retroperitoneal fluid (this case is an example of a post HBC)

Question 29

Primary peritoneal neoplasia includes:

Answer 29

mesothelioma

leiomyoma

carcinoma

Question 30

Radiographic findings and dx

Answer 30

Mineral opacities located cranio-dorsal to the kidneys. Mineralization os adrenal glands (non-neoplastic adrenal glands)

Question 31

What are the radiographic findings of pancreatitis?

Answer 31

Increased soft tissue opacity in the cranial right abd

soft tissue mass effect caudal to the stomach

focal decreased serosal margination in cranial right abd.

gast distended descending duodenum (sentinel loop sign)

displacement of adjacent intestinal structures

***radiographs may appear normal****

Question 32

What does the adrenal cortex secretes? What about the medulla?

Answer 32

The cortex secrets steroid hormones, including cortisol, aldosterone, androgens, and estrogen. The medulla produces catecholamine.

Question 33

Causes of medial iliac LN enlargement?

Answer 33

neoplasia (most common- lymphosarcom, metastatic)

inflammatory

Question 34

Most common pancreatic tumors

Answer 34

insulinoma

pancreatic adenocarcinoma

Question 35

Differential diagnoses for decreased serosal margination

Answer 35

lack of intraabdominal fat

brown fat (young patient)

peritoneal effusion

peritonitis

peritoneal neoplasia

mass effect crowding

superimposed external material (wet hair, u/s gel etc.)

underexposure

** smaller amounts of peritoneal fluid, peritonitis, or carcinomatosis may produce a mottled, hazy or irregular loss of contrast***

Question 36

What’s your diagnosis?

What are the ddx?

Answer 36

Pneumoperitoneum

Ddx: gi perforation, recent abd sx, gas producing bacteria, penetrating wound in abd wall

Question 37

Measurements of the canine and feline pancreas and CBD

Answer 37

The normal width (ventral to dorsal dimension)
of left lobe and body of the pancreas are approximately 0.25
to 1.0 cm, and the right lobe is commonly reported slightly
smaller at between approximately 0.3 and 0.6 cm. The
maximum dimension of the right lobe of the pancreas in healthy
dogs was reported up to range between 0.9 to 2.1 cm; however,
it is unclear if the measurement corresponded to the ventro
dorsal maximum dimension reported in other studies. The
feline pancreatic duct width should normally be less than
approximately 0.25 cm,
which is similar to the dog.