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- Ultrasound Clue: Thinned, Bright Lymph Nodes Signal Cushing’s in Neutered Dogs
Ultrasound Clue: Thinned, Bright Lymph Nodes Signal Cushing’s in Neutered Dogs
JAVMA 2025
Obi Veterinary Education
October 21, 2025
Maxime Frouin, Laurent Blond, Franck Jolivet, Clément Baudin-Tréhiou
Background
Hyperadrenocorticism (Cushing’s syndrome) in dogs leads to chronic hypercortisolism, which causes lymphoid tissue atrophy through lymphocytolysis and suppressed lymphocyte production. The authors observed during routine abdominal ultrasonography that neutered dogs with spontaneous hyperadrenocorticism (sHAC) often had thinner and hyperechoic jejunal and medial iliac lymph nodes. This study aimed to determine whether these imaging features consistently distinguish dogs with sHAC from healthy neutered controls.
Methods
A prospective study (May 2023–January 2025) was conducted at a French veterinary hospital including 28 neutered dogs with confirmed sHAC and 30 clinically healthy neutered controls. Diagnosis of sHAC followed ACVIM guidelines using low-dose dexamethasone suppression and/or ACTH stimulation tests. Abdominal ultrasound examinations measured lymph node thickness and echogenicity of jejunal and medial iliac nodes using standardized imaging protocols. Data were analyzed by weight subgroup (<10 kg, 10–20 kg, >30 kg) using nonparametric statistical tests, with P < 0.05 considered significant.
Results
-Dogs with sHAC had significantly thinner lymph nodes than healthy controls across all weight groups.
-Thinned lymph nodes: 93% (26/28) for jejunal; 96% (27/28) for medial iliac.
-Hyperechogenicity: 64% (18/28) of jejunal and 71% (20/28) of medial iliac nodes versus ≤7% in controls.
-Odds ratios: 23.53 (95% CI 4.45–243.91) for hyperechoic jejunal and 65.70 (95% CI 8.29–3041.06) for medial iliac nodes.
These findings remained significant after multiple comparison correction. No differences in age or body weight existed between groups, confirming comparability.
Limitations
Histopathologic confirmation of lymph node changes was not performed due to ethical constraints. Potential confounding from other diseases or hormone effects could not be fully excluded. The study did not distinguish between pituitary-dependent and adrenal-dependent forms of sHAC. Larger and longitudinal studies are needed to confirm histologic correlates and diagnostic utility.
Conclusions
Neutered dogs with spontaneous hyperadrenocorticism consistently display thinner and hyperechoic jejunal and medial iliac lymph nodes on ultrasonography compared to healthy neutered dogs. These features likely reflect lymphoid tissue involution secondary to chronic glucocorticoid excess. Recognition of these sonographic changes may assist veterinarians in suspecting Cushing’s disease during abdominal imaging, complementing hormonal testing in diagnostic workflows.
Representative B-mode ultrasound images of jejunal and medial iliac lymph nodes in a clinically healthy neutered dog (A and C) and a neutered dog with spontaneous hyperadrenocorticism (sHAC; B and D) of the same weight (10 kg) were acquired with a broadband curved array transducer (3 to 12 MHz). The jejunal and medial iliac lymph nodes (arrowheads) appear thin and hyperechoic in the sHAC case (B and D) and of normal size and echogenicity in the clinically healthy case (A and C).
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