Case of the week 1.4.21
Publication Date: 2021-01-04
History
10 year old domestic short hair cat. Hyporexia.Weight loss.
3 images
Findings
Study: Opposite lateral and VD radiographs of the abdomen are available for interpretation.
Abdomen: The patient is thin with tenting of the dorsal cutaneous margins by the spinous processes. There is decreased serosal detail in the retroperitoneal space with moderate fluid streaking, most severe at the level of the kidneys. The kidneys are mildly to moderately enlarged with irregular margination. The serosal detail of the peritoneal cavity is normal. There is a small, lobular, soft tissue opaque mass in the cranioventral aspect of the abdomen, superimposed with an intestinal segment immediately caudal to the costal arches. On both lateral projections, there is a small amount of pinpoint to stippled mineral opaque foci at the level of this mass. A small intestinal segment in the mid abdomen, slightly dorsal to and superimposed with the colon contains a moderate volume of pinpoint mineral opaque foci, and there is suspected thickening of the wall of this intestinal segment. The remainder of the small intestines contain a small to moderate volume of gas and are normal in diameter. The colon and stomach are normal. There is a fusiform soft tissue opacity in the plane of the caudal abdomen, ventral to the colon and caudodorsal to/superimposed with the urinary bladder. The liver is small. The urinary bladder and spleen are normal.
Diagnosis
Conclusions:
- Partially mineralized small intestinal mass and focal small intestinal wall thickening are concerning for a multifocal neoplastic process, such as lymphoma. Intraluminal mineral material at the level of the small intestinal wall thickening may be transient, though consideration should be given to a gravel sign representing a partial, chronic obstruction at that level.
- Bilateral renomegaly with irregular margination and retroperitoneal effusion raises concern for concurrent neoplastic infiltration (such as lymphoma), though bilateral pyelonephritis with chronic degenerative changes cannot be entirely excluded.
- The fusiform soft tissue opacity in the caudal abdomen may represent an unusual location of an enlarged sublumbar lymph node, given its position ventral to the colon. A non-organ associated mass is possible. Given the reported signalment, reproductive origin is unlikely.
- Microhepatia may be a patient variant or may represent a chronic hepatopathy, and this finding should be interpreted in light of clinical findings.
- Thin body condition and cachexia.
Discussion
The patient underwent abdominal ultrasound where the changes were confirmed. FNAs of the right sublumbar lymph node yielded the diagnosis of lymphoma
Notes
The patient was initially seen on radiology by Dr Debow
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