Gossypiboma in a canine female spayed 3year old German shorthaired pointer
By Soundiagnosis April 2024
History:
A 3-year-old female-spayed German Shorthaired Pointer was presented to a Melbourne veterinary clinic for gradual weight loss despite normal appetite. Physical examination and abdominal radiographs revealed a large abdominal mass. Soundiagnosis mobile veterinary ultrasound was called to perform an abdominal ultrasound to investigate the mass further.
Soundiagnosis Image Interpretation:
There was a large rounded cavitated mass in the right-mid abdomen measuring approximately 8.02 cm x 6.92 cm x 6.33 cm, which did not appear connected to any organ. This mass displayed a thick hypoechoic capsule with irregular invaginations of echogenic tissue within it and central anechoic areas suggestive of fluid. The mass displayed some vascularisation around the periphery when colour Doppler was applied. There was also irregular hypoechoic tissue within the peritoneum surrounding the mass, which displayed vascularisation when colour Doppler was applied. The peritoneal fat surrounding this tissue was hyperechoic. There was also a small amount of anechoic abdominal effusion. The hepatic and pancreaticoduodenal lymph nodes were enlarged and heterogeneous in echotexture. The jejunal and medial iliac lymph nodes were hypoechoic and displayed upper normal size but preserved normal shape.
Differential Diagnosis:
Large cavitated mass in the right mid-abdomen with a thick capsule and irregular folds of echogenic tissue. DDx. Gossypiboma (retained surgical swab); other walled off foreign material; abscess or granuloma; parasitic cyst; cystic neoplasia less likely. Irregular hypoechoic vascularised tissue in the peritoneum adjacent to the mass. DDx. Adhesions/inflammatory tissue most likely; infiltrative neoplasia in the peritoneum less likely.Enlarged heterogeneous hepatic and pancreaticoduodenal lymph nodes, hypoechoic jejunal and medial iliac lymph nodes. DDx. Reactive lymph nodes; lymphadenitis; metastatic neoplasia less likely.
Outcome and comments:
An exploratory laparotomy was performed and the cavitated mass was successfully removed but displayed large amounts of adhesions in the surrounding peritoneum. Examination of the mass after removal confirmed the presence of two retained surgical swabs within the mass. These surgical swabs were most likely left behind during ovariohysterectomy and created a foreign body reaction within the peritoneum. The patient is expected to make a full recovery.
Images:
Image 1 and 2: Large cavitated mass in the right-mid abdomen showing a thick hypoechoic capsule and invaginations of echogenic tissue within it as well as anechoic areas suggestive of fluid.
Image 1 and 2: Large cavitated mass in the right-mid abdomen showing a thick hypoechoic capsule and invaginations of echogenic tissue within it as well as anechoic areas suggestive of fluid.
Image 5: Irregular vascularised hypoechoic tissue in the peritoneum adjacent to the mass, surrounded by hyperechoic peritoneal fat.