Case of the week 7.11.22
Publication Date: 2022-07-11
History
10 year old male castrated cat. 1 week history of diarrhea, 4-5days history of anorexia
3 images
Findings
Orthogonal radiographs of the abdomen are available for interpretation.
There is markedly decreased peritoneal serosal margin detail, with increased soft tissue opacity in the caudal and ventral aspect of the abdomen and wispy soft tissue opacity superimposed with the falciform fat and mid-ventral abdomen. There is a somewhat mottled or nodular pattern to the loss of detail. The stomach is gas filled and normal in size and position. The majority of the small intestinal margins are obscured.
There is a mass effect in the mid-right abdomen in the area of the ascending colon, with caudal displacement of the small intestines. The descending colon contains gas and fluid/soft tissue opaque material.
Diagnosis
- Marked peritoneal effusion and mid-abdominal mass effect. Consideration is given to an intestinal neoplastic mass (colon/ICJ) +/- mesenteric lymphadenopathy. The mottled peritoneal effusion is concerning for carcinomatosis. Abdominal ultrasound is recommended for further evaluation.
Discussion
On ultrasound there was a large, heterogeneous, eccentric mass arising from the intestinal tract at the level of the ileocolic junction (colon vs. cecum) most consistent with a malignant etiology (such as lymphoma, adenocarcinoma, leiomyosarcoma or gastrointestinal stromal cell tumor). Multiple hypoechoic nodules in the mesentery adjacent to the mass are most concerning for lymphomatosis/carcinomatosis/sarcomatosis with associated peritonitis/steatitis.
The patient was subsequently euthanized at the owner's request and due to poor prognosis. The top differentials for this mass were a leiomyosarcoma vs a gastrointestinal stromal tumor (GIST).
Notes
This case was initially seen by Dr. Fazio on the clinic floor.
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