Case of the week 7.25.22
Publication Date: 2022-07-25
History
12 year old domestic shorthair. Female spayed. Lethargy and anorexia for 2 days.
3 images
Findings
The patient is thin with tenting of the skin over the spinous processes.
Abdominal serosal detail is normal. Within the cranial abdomen, there is a large, lobular, soft tissue opaque mass which is confluent with the ventral aspect of the left liver and displaces the stomach caudally and dorsally.
The stomach contains a mild volume of gas. The small intestines contain a mild volume of homogeneously soft tissue/fluid opaque material and gas. The colon contains a mild volume of fecal material and gas.
Best identified on the ventrodorsal image, there is a tortuous, soft tissue opaque structure within the left caudal abdomen which is present caudal and medial to the splenic head. The kidneys and urinary bladder are normal.
There is mild to moderate degenerative joint disease of the coxofemoral joints. There is mild, multi-focal, incidental spondylosis deformans.
Diagnosis
The lobular, soft tissue opaque mass within the cranial abdomen which appears confluent with the liver is most concerning for primary hepatic neoplasia and may represent benign processes (such as hepatoma) or malignant processes (such as hepatocellular carcinoma).
The tortuous, soft tissue opaque structure caudal and medial to the spleen is most consistent with a “spaghetti sign” and likely represent collateral spleno-systemic circulation. - Mild to moderate coxofemoral degenerative joint disease (left worse than right).
Discussion
The patient underwent ultrasound and FNAs of the mass were performed. The samples were consistent with either biliary adenoma or adenocarcinoma.
The splenocaval vascular malformation was confirmed.
https://pubmed.ncbi.nlm.nih.gov/28868753/
Notes
Case initially seen by Dr. Monto
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