MAY 2023

Corneal ulcer

Identification and history

  • Name: Boby
  • Report: Canine, half-breed, neutered male, 8 years old.

Differential diagnosis: suspected corneal ulcer complicated by bacterial infection.

Past medical history: Gastrointestinal symptoms with hematochezia, dysorexia and progressive weight loss.

Ocular Ultrasound Exam

Corneal ulcer 1

We observed a neoformation on the lateral aspect of the orbital cavity, resulting in compression of the ocular globe. This neoformation has almost well-defined margins, heterogeneous echogenicity with a positive Color Doppler signal.*

Corneal ulcer 2

During the clinical examination, at the left flank level, we reported the presence of two subcutaneous lesions, mobile and compact in consistency, which have well-defined margins and heterogeneous echogenicity; positive Color Doppler signal.*

FNA → Cytological exam: "Malignant round cell neoplasm, first hypothesis high-grade lymphoma".

Following the outcome of the cytological examination of the skin and eye lesions, we requested an abdominal ultrasound examination in order to complete the diagnostic procedure for patient staging.

Abdominal Ultrasound

Corneal ulcer 3

In the liver parenchyma, we note the presence of rounded multifocal lesions, with blurred margins and iso-anechoic heterogeneous echogenicity associated with slight blocking of the organ profile.

Corneal ulcer 4

Mild scattering of perihepatic mesenteric adipose tissue.

Corneal ulcer 5

Peritoneal lesions with irregular margins, millimetric, with echostructure and echogenicity similar to the liver lesions described above.

Corneal ulcer 6

At the gastrointestinal level, multifocal wall thickening with eccentric growth is evident, with partial loss of the stratigraphy, mainly hypoechoic in the absence of mechanical obstruction phenomena.*

Corneal ulcer 7

We can appreciate:

  • Generalized abdominal lymphadenopathy, loss of fat hilus, impaired short/long axis ratio, heterogeneous and hypoechoic parenchyma. *
  • Heterogeneous and hypoechoic splenic parenchyma with rare round, well-defined and hyperechoic lesions. **
Corneal ulcer 8

There is mild diffuse peritoneal scattering with little accumulation of anechoic effusion and an infiltrative lesion of the transverse abdominal fascia near the linea alba, iso-hypoechoic to the intestinal muscle.*

Corneal ulcer 9

We further studied the lymph node vascularization, apparently negative to the Color Doppler signal, using the microV, thanks to which a low flow vascularization was highlighted, with the presence of pericapsular/subcapsular vessels.

Corneal ulcer end

FNA of the abdominal visceral lesions is performed with the following outcome: “Cytological picture compatible with malignant round cell neoplasm, in the first hypothesis high-grade lymphoma”.

Images were acquired with MyLab™X8VET ultrasound system.
The speed of some clips could have been modified to improve the visualization of the clinical outcome.

Conclusions and treatment

Patient currently awaiting immunophenotyping and cancer treatment.

Mariaceleste Gendusa DVM, Clinica Veterinaria Gran Sasso, Italy

Mariaceleste Gendusa, DVM

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