Case of the week 5.20.19
Publication Date: 2019-05-20
6 images
Findings
Opposite lateral and VD radiographs of the thorax and abdomen.
There is moderate to severe pleural effusion. The lung lobes are retracted and rounded. There is widening of the cranial mediastinum on the VD view and there is the impression of caudodorsal displacement of the cranial lung lobes. The cardiac silhouette is largely obscured, but does not appear overly enlarged. The pulmonary vessels are normal.
There is severe decreased serosal detail in the mid and cranial peritoneal space, with concurrent presence of a mass effect, and mottling of the cranial peritoneal space. On the VD view, a large, lobular, ill-defined soft tissue opaque mass, up to 10cm in diameter, is clearly seen in the left mid cranial abdomen, resulting in peripheral displacement of the small intestines. The small intestines are partially obscured but are normal in diameter. The cranial aspect of the descending colon is displaced towards the right on the VD view. The liver is normal. The spleen is mostly obscured. The unobscured margins of the kidneys are normal. The urinary bladder is not seen.
There is a transitional L7 vertebra with sacralization. The left femoral head is mildly flattened with moderate osteophytosis and there is the impression of osteopenia of the proximal left femur.
Diagnosis
- Moderate to severe pleural effusion; suspect cranial mediastinal mass and/or mediastinal lymphadenopathy; cranial mid abdominal mass, most likely severe mesenteric lymphadenopathy; and peritoneal effusion consistent with the working diagnosis of lymphoma. Repeat radiographs of the thorax or CT of the thorax after thoracocentesis, and abdominal ultrasound could be performed for further evaluation.
- Left coxofemoral degenerative joint disease. The impression of left femoral osteopenia may be artifactual. Repeat radiographs centered on the hips could be performed for further evaluation.
Discussion
The dog was diagnosed with B-cell lymphoma, and is undergoing chemotherapy.
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