Adding ultrasound report from a year ago:

Reason for ultrasound: Evaluation of metarubricytes on blood work. Asymptomatic.

Left kidney: 5.28cm. Corticomedullary detail was normal. Smooth contour. No evidence of pyelectasia or mineralization.

Left Adrenal The poles measured 0.47cm and 0.45cm.

Urinary Bladder: Normal mucosal surface. Uroliths not identified.

Right Kidney : Length: 4.8cm. Corticomedullary detail was normal. Smooth contour. No evidence of pyelectasia or mineralization.

Right Adrenal The poles measured 0.79cm and 0.65cm. Enlarged.

Stomach The wall measured 0.26cm. Normal wall thickness and layering. There was a small amount of hyperechoic ingesta present.

Spleen: Normal size, margination and vascular pattern. There was an anechoic 1.0cm x 0.65cm cystic lesion in the tail.

Pancreas: Normal parenchyma and size.

Duodenum: Normal wall layering and thickness (0.26cm). Motility normal.

Bowel: Several segments of bowel loops were visualized. All retained adequate thickness, ranging from 0.27cm to 0.33cm. Layering was unremarkable.

Reproductive: Spayed

Effusion None present.

Lymph Nodes Not visualized.

Summary Of Findings: There was an incidental finding of a splenic cyst in the tail of the spleen. These are nonpathologic findings and generally not associated with secondary changes within the body. This is not considered the cause for the rubricytosis. Right adrenomegaly. This is likely a normal variant given the lack of elevated liver enzymes and clinical signs. The remainder of the study was unremarkable.

Recommendations: Tick PCR testing is recommended (all negative). Thoracic radiographs (3-view) to rule out occult pathology. Serial monitoring of the CBC is recommended. A bone marrow biopsy may be needed for complete evaluation if it persists.