• Mixed-breed dog of medium-small size, female, 10 years old.
• Recent history: underwent two mastectomy surgery, one carried out about 15 days before and the other about 1 month after the previous one.
• Recent anamnesis: for about 2 days despondency, irrepressible vomiting and anorexia.
• Severe sensory depression, dyspnea, injected and congested mucous membranes, body temperature 40°. Addome dolente ed impalpabile. Painful and impalpable abdomen.
• Laboratory tests not available.

The ultrasound examination, in parasagittal longitudinal scan, performed through an acoustic window at the level of the right hypochondrium, highlights an expansive formation with irregular and blurred limits, an inhomogeneous echostructure due to the presence of a central hypoechoic area, arranged caudal to the body of the stomach and ventral to the right kidney.

In transversal scan, through an acoustic window at the level of the right hypochondrium, the expansive formation with irregular and blurred limits, an inhomogeneous echostructure due to the presence of a hypoechoic central area, continues caudally, arranged dorsally to the descending duodenum and ventrally to the right kidney.

The expansive formation highlighted, due to the anatomical relationships, is to be referred to the pathologically enlarged and altered body and cranial portion of the right lobe of the pancreas. The detail of the structures of the examined region appears diffusely reduced. The ultrasound image appears compatible with pancreatitis or localized peritonitis. Due to the severity of the clinical symptoms and prognostic reserve, the owners decided to euthanize the dog.

The pancreas is an organ that is difficult to evaluate using Diagnostic Imaging techniques. The clinical case presented confirms, however, the high sensitivity of the ultrasound examination in the diagnosis of pancreatic pathologies. However, the anatomical location of the pancreas between the stomach, duodenum and colon can make its visualization particularly difficult due to the gaseous content of these hollow organs.

On ultrasound, the normal pancreas appears diffusely hyperechoic and grossly glandular acinar in structure. Its limits can hardly be defined with respect to the fat of the surrounding meso and epiploon, which is why it is often referred to as the “pancreatic area”. The anatomical landmarks are: cranially, body and pyloric antrum of the stomach; laterally, descending duodenum; medially and caudally, ascending and transverse colon; dorsally, portal vein, caudate hepatic lobe and right kidney.

In the present case, the diagnostic suspicion of pancreatitis issued on the basis of clinical and ultrasound data (enlargement of the pancreatic area associated with the presence of central hypoechoic areas and a reduction in the anatomical detail of the region). Accessory findings, detectable in the case of pancreatitis, can be: duodenal austrature (sign of irritation of the organ), peritoneal flap located in the right cranial quadrant, dilatation of the gallbladder.

The autopsy examination subsequently confirmed the clinical suspicion.