Feline abdominal ultrasonography: What’s normal? What’s abnormal? The pancreas

Abstract

Practical relevance: Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the pancreas is a vital part of the investigation into feline pancreatic disease. Clinical challenges: Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings such as nodular hyperplasia and pathological changes such as neoplasia can be challenging. Aim: This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination and appearance of the normal and diseased pancreas. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. Equipment: Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. Evidence base: Information provided in this article is drawn from the published literature and the author’s own clinical experience.

Evaluation of Clinicopathological Data, the Specific Feline Pancreatic Lipase Assay, and Abdominal Ultrasound as Severity Determinants in Cats with Pancreatitis

“…Concurrent chronic enteropathy, cholangiohepatitis, and hepatic lipidosis have been reported in approximately 50% of cats with pancreatitis [ 5 , 13 , 29 , 30 ]. It is therefore recommended that the liver and gastrointestinal tract are evaluated at the same time as the pancreas [ 31 ]. In our study, 42% of cats had evidence of concurrent hepatic abnormalities on ultrasound, and 31% had evidence of concurrent gallbladder abnormalities.…”

Feline Comorbidities: Clinical perspective on diabetes mellitus and pancreatitis

“…11 In cases where ultrasonographic examination of the pancreas is unremarkable but clinical suspicion of pancreatitis is high, it has been recommended that ultrasound examination is repeated 2-4 days later. 30,31…”

“…[26][27][28][29] For imaging, abdominal ultrasound is currently considered the modality of choice for the diagnosis of pancreatitis in cats (Figure 1). 11 (See Griffin 30 for a review of ultrasonographic examination of the normal and diseased pancreas.) it is important to note that a normal pancreas on ultrasound examination cannot rule out pancreatitis.…”

“…11 in cases where ultrasonographic examination of the pancreas is unremarkable but clinical suspicion of pancreatitis is high, it has been recommended that ultrasound examination is repeated 2-4 days later. 30,31 Recommended diagnostic work-up for cats with DM and suspected pancreatitis it is the authors' opinion that cats with dM should be examined at least once for pancreatitis using Spec fPL and/or abdominal ultrasound. in cats with good glycaemic control and no other clinical signs, repeated testing for pancreatitis may be performed every 6-12 months.…”

The ultrasonographic appearance of renal medullary striations and their association with renal disease and renal histopathology in domestic cats

“…A hyperechoic band paralleling the corticomedullary junction known as the medullary rim sign (MRS), have been widely described in cats and dogs with and without kidney disease (KD) 1,3,5,6–14 . A hypoechoic band (halo sign) described in cases of ethylene glycol toxicity 9,15 and, radiating hyperechoic bands affecting both the cortex and medulla have been reported in cats with chronic end‐stage KD 1,16 …”