Case of the week 6.4.18
Publication Date: 2018-06-04
History
11 year old male labrador retriever. 10 day history of poor ambulation. For the last 2 months history of abdominal pain.
8 images
What do You think ?
- The prognosis for this patient is:Excellent, there's just a bit of degenerative osseous changes. Treat with NSAIDs, will be fine
No :(Good, it's a straight forward surgical problem. As long as the surgery goes well the dog will be fine
No :(Fair, there seems to be a localized process. Getting a sample is the next step to evaluate treatments' options
No :(Grave, there is a diffuse neoplastic process affecting multiple systems. Quality of life is compromised
Yes :-(
Findings
Opposite lateral and VD radiographs of the thorax and abdomen are acquired.
There are multifocal round soft tissue opaque nodules of varying size, the largest of which measure approximately 1.0cm in diameter.
Additionally, there is a diffuse mild unstructured interstitial pattern. The cardiovascular structures are normal. There is an incidental separate center of ossification of the left infraglenoid tubercle with a pointed osteophyte at the caudal apsect of the corresponding humeral head.
There is mild decrease peritoneal and retroperitoneal detail characterized by soft tissue streaking. The prostate is moderately enlarged and contains ill-defined stippled mineralization.
There is ill-defined increased soft tissue opacity with stippled mineralization ventral to the sixth and seventh lumbar vertebrae.
There is irregularly marginated osseous proliferation ventral to the sacrum with mild to moderate moth-eaten lysis of the left sacroiliac joint. Centered on the caudal aspect of the third lumbar vertebra and the L3-L4 articular facets, there is a focal region of moderate moth-eaten lysis. This lysis can be seen affecting both pedicles on the VD view.
The liver and spleen are normal. The unobscured portion of kidneys and the urinary bladder are normal. The gastrointestinal tract, liver and spleen are normal. Incidental spondylosis deformans is seen at the thoracolumbar junction.
Diagnosis
The described changes are most consistent with prostatic neoplasia (carcinoma) with multifocal metastasis to the lungs, sub-lumbar lymph nodes, lumbar spine, sacrum and sacroiliac joint; the moth-eaten apperance of the left sacroiliac joint may however be accentuated on the VD by superimposition with fecal material in the colon.
Loss of peritoneal and retroperitoneal detail may represent neoplastic effusion / carcinomatosis, hemorrhage or inflammatory effusion.
Outcome
The owner elected to humanely euthanize the patient based on the overall poor prognosis and quality of life.
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