2-year-old spayed female Labrador
This dog presents for lethargy, vomiting, and anorexia of 2 days duration. The abdomen is painful on palpation.
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Major findings
- Non-obstructive, circumferential mural mass involving the descending duodenum with mucosal irregularity
- Wide gastroduodenal angle
- Reduced serosal detail in the right cranial abdomen
- Wispy soft tissue in the retroperitoneal space
Minor findings
- Barium reflux into the esophagus on the 30 minute study
- Corrugated jejunum
- Mural duodenal mass may be non-infectious inflammatory (ulcer, duodenitis) from external causes (pancreatitis, pancreatic neoplasia), infectious inflammatory (fungal) or neoplastic (adenocarcinoma)
- Right cranial quadrant peritonitis from pancreatitis, pancreatic mass or inflammation from bowel mass
- Ultrasound to look for pancreatic involvement and perform aspirates of the mass and/or fluid
- Thoracic radiographs to assess for metastatic disease
- All candidates identified an abnormality of the duodenum. Many candidates failed to recognize that the lesion was mural and diagnosed a foreign body. Several candidates did not recognize that the right cranial quadrant was abnormal outside the duodenum and/or did not identify regional peritonitis. Unsuccessful candidates identified multiple lesions in the bowel leading to a diagnosis of infiltrative disease throughout the jejunum. Several candidates listed neoplasia as their only differential despite the signalment and history of the dog.