1. Adrenals, Lymphnodes, Gall Bladder, and Pancreas
Jane MacLellan

2. Adrenal Glands In the dog - peanut shaped In the cat - more oval
Located cranial and medial to kidneys
Left - caudal to the branches of the aorta
Right - adjacent to caudal vena cava
Locate kidney, then fan medially with probe
Hypoechoic - similar to blood vessels
Can be hard to distinguish - use doppler
Overlying bowel can obscure

4. Adrenal Gland Disease Measure length and width
Length with vary between animals
Proportional to body weight
Width does not
Width may increase with disease
Normal width = < 0.74 cm
Note: New paper suggests dogs < 10Kg normal width < 0.6 cm

5. Adrenal Gland Disease Pituitary dependent hyperadrenocorticism
Bilaterally enlarged
Normal shape - but ‘plump’
Thickened poles
Uniformly hypoechoic
Nodular hyperplasia
Normal size does not r/o PDH

6. Adrenal Gland Disease Adrenal tumor Gland enlargement Abnormal shape
Change in echotexture
Unilateral masses more common
Can’t distinguish benign from malignant tumors
May be able to tell if invading surrounding tissue

8. Lymph nodes More sensitive then radiographs
Medial iliac and jejunal lymph nodes
Large
More often seen when normal
Normal - same echogenicity as surrounding mesentery
Easier to see in young, thin animals
When enlarged, more hypoechoic
Can do ultrasound guided FNA

9. Lymph nodes Medial iliac Visceral
Near terminal portion of aorta and caudal vena cava
Not normally seen unless enlarged
Bladder, prostatic neoplasia
Visceral
Seen when doing routine scan

11. Gall Bladder Visualized just right of midline in liver
Size is variable - depending on last meal
Fasting or anorexia
In cats, can be bi-lobed
Things you might see
Thickened wall
Stones
Mucoceles
Cholestasis
Cholecystitis
“Sludge”
Icterus

12. Thickened Wall Wall normally thin, echogenic, poorly visualized
<1mm in cats, slightly thicker in dog
Double layered - inside and outside surfaces – Halo sign
Thickening is a non-specific sign
Chronic hepatitis
Cholecystitis
Cholangiohepatitis
Right CHF
Hypoalbuminemia
Sepsis
Neoplasia

13. Sludge
Commonly seen
Especially if haven’t eaten recently
Dependent

14. Mucocele Cystic mucinous hyperplasia Proliferation of GB epithelium
Increased mucin production
Marked distension of the GB
Kiwi appearance
Cystic mucinous hyperplasia is characterised by papillary proliferation of the gall bladder epithelium with increased mucin production. Sometimes there is extreme mucin production with marked distension of the gall bladder (mucocele)

15. Choleliths Uncommon Incidental finding
Should be noted - cholecystitis or biliary obstruction
Hyperechoic
Acoustic shadowing
Mobile

16. Bile Duct Seen as a continuation of the GB
Dogs - not consistently seen
Should be < 3mm
Cats - more often seen
Should be < 4mm
Ventral to portal vein
Extrahepatic obstruction
Dilation of GB and bile duct

17. GB Artifacts Mirror image duplicate Refraction Acoustic enhancement
Sound wave bounces off the diaphragm, echos off the gall bladder back towards diaphragm, reflected towards the transducer
Refraction
When sound waves go through tissues of different acoustic impedance
Acoustic enhancement
Less attenuation compared to liver

18. Pancreas Normal is routinely difficult to visualize
Echogenicity similar to surrounding fat
No defined capsule
Less echogenic then spleen, more echogenic then liver
Right limb just dorsal to duodenum
More likely to see in puppies, thin dogs, or with free abdominal fluid

19. Pancreatitis Acute - surrounded by a hyperechoic area
Due to peri-pancreatic fat necrosis
Severe - mixed echogenicity
Chronic - hyperechoic pancreas
Due to pancreatic fat necrosis
Pancreatic pseudocysts
Mass effect
In acute cases a hypoechoic pancreas is often surrounded by a hyperechoic area that is due to peripancreatic fat necrosis. In dogs with severe pancreatitis, the sensitivity for various degrees of peripancreatic fluid accumulation was 68%. 1 Chronic pancreatitis can be associated with a hyperechoic pancreas indicating the presence of pancreatic fibrosis.

22. Pancreas Neoplasia Difficult to identify
Looks similar to pancreatitis (mass effect)
Fluid accumulation
Invasion of surrounding tissues
Evidence of metastasis in other organs