Avaliação semiológica e diagnóstico em pequenos animais - AULA 27

Summary

This veterinary class focuses on the evaluation of splenic and adrenal pathologies using ultrasonography. The lecture covers focal and diffuse changes in the spleen, including tumors, cysts, abscesses, and conditions like lymphoma. It also addresses blood flow issues such as thrombus formation and splenic torsion. Additionally, adrenal gland pathologies are explored, with emphasis on structural changes, neoplasms, and hormone imbalances like hyperadrenocorticism. The importance of combining clinical findings with ultrasound imaging for accurate diagnosis is highlighted, emphasizing the need for careful differential diagnosis in both common and complex cases.

Takeaways

• 😀 Focal alterations in the spleen can include tumors, cysts, abscesses, and localized neoplasms such as lymphoma.
• 😀 Diffuse alterations in the spleen may result from vascular congestion due to blood flow obstructions or large masses.
• 😀 Ultrasound is a valuable tool for identifying thrombi in the spleen by assessing vascularization with Doppler imaging.
• 😀 Spleen torsion can lead to vascular occlusion, resulting in necrosis, with ultrasound showing reduced vascularity and changes in echogenicity.
• 😀 Lymphoma in the spleen can present as a diffuse change with a granulated echotexture that may resemble liver tissue on ultrasound.
• 😀 Cysts and abscesses in the spleen are differentiated based on their wall characteristics and internal content, which can be seen on ultrasound.
• 😀 Myelolipomas are benign fatty tumors that present as hyperechoic areas in the spleen or adrenal glands, typically non-problematic for the animal's health.
• 😀 In adrenal pathologies, ultrasound helps assess gland size, shape, echogenicity, and its relationship to nearby structures like the vena cava and abdominal artery.
• 😀 Hyperadrenocorticism (Cushing’s syndrome) can result in asymmetry between the adrenal glands, with one side hypertrophic and the other atrophic.
• 😀 Neoplastic changes in the adrenal glands may show irregular shape, mixed echotexture, and possible vascular involvement with the nearby vessels, such as metastasis to the vena cava.

Q & A

What is the main focus of the lesson in the transcript?

The lesson primarily focuses on evaluating pathologies related to the spleen and adrenal glands, including both focal and diffuse alterations in these organs.

How are alterations in the spleen categorized?

Alterations in the spleen are categorized into focal and diffuse changes. Focal changes include conditions like tumors, localized neoplasms, cysts, and abscesses, while diffuse changes involve conditions such as congestion or splenic torsion.

What causes splenic congestion, and how is it identified on ultrasound?

Splenic congestion can be caused by a blockage in blood flow, leading to the engorgement of vessels. On ultrasound, it can be identified by an increase in echotexture and echogenicity in the affected area, often indicating thrombosis or obstruction.

What is the significance of Doppler ultrasound in evaluating spleen pathologies?

Doppler ultrasound helps to differentiate whether an area of the spleen is being vascularized. It can indicate the presence of a thrombus by showing the lack of blood flow in certain regions, as in cases of splenic torsion or thrombosis.

What are the characteristics of a splenic torsion on ultrasound?

In splenic torsion, ultrasound shows an area with no vascularization, increased echogenicity, and possible necrosis due to the strangulation of blood vessels. The affected spleen tissue may appear anechoic as a result of cell death.

How can lymphoma affect the spleen, and how is it identified on ultrasound?

Lymphoma causes diffuse alterations in the spleen's echotexture, which becomes more granular and heterogeneous. On ultrasound, it appears as an area with mixed echogenicity and a diffuse, irregular pattern, which is suggestive of lymphoma.

What is the most common diagnosis when a cystic structure is observed in the spleen?

The most common diagnosis when a cystic structure is observed in the spleen is a simple splenic cyst. This is characterized by a thin, regular wall and a mixed internal content, but other differentials such as abscesses may also be considered based on the animal’s clinical condition.

What are myelolipomas, and how can they be identified in ultrasound images?

Myelolipomas are benign tumors made up of fat and bone marrow elements, commonly located at the hilum of the spleen. On ultrasound, they appear as hyper-echoic (bright) areas due to the fat content.

What are the challenges in diagnosing adrenal gland issues via ultrasound?

Diagnosing adrenal gland issues via ultrasound can be challenging because changes in size, shape, and echogenicity are not always specific to a particular condition. For instance, hyperadrenocorticism can cause one adrenal gland to hypertrophy while the contralateral gland atrophies.

How can adrenal gland neoplasms be differentiated from other conditions using ultrasound?

Adrenal gland neoplasms typically present as areas with irregular echogenicity, mixed echotexture, and irregular walls. Ultrasound can also reveal metastasis within adjacent blood vessels. A thorough clinical history and complementary tests are crucial for confirming the diagnosis.