-12 year old cat
-3 pound unexplained weight loss, no real clinical signs
-Mesenteric lymphadenopathy, FNA came back as reactive
-Dilated bile duct, no obstruction
-Generalized hyperechoic liver
-I thought I saw something in the caudal thorax, viewed through the liver. Radiographs didn’t show anything so I was likely mistaken. Am I just seeing some combination of artifacts there?
-I am assuming the most likely diagnosis is IBD or triaditis. Any other thoughts?
Suzanne
-12 year old cat
-3 pound unexplained weight loss, no real clinical signs
-Mesenteric lymphadenopathy, FNA came back as reactive
-Dilated bile duct, no obstruction
-Generalized hyperechoic liver
-I thought I saw something in the caudal thorax, viewed through the liver. Radiographs didn’t show anything so I was likely mistaken. Am I just seeing some combination of artifacts there?
-I am assuming the most likely diagnosis is IBD or triaditis. Any other thoughts?
Suzanne
Comments
Not seeing anything through
Not seeing anything through the diaphragm but i would fna the LN and culture after fna with a touch of salinge in the syringe. Length to width ratio is conserved in the LN so more likely reactive. Assess maldigestive panel a lot of triad cats go that route instead of neoplasia. Chest rads and full cns exam to assess for occult disease causing weight loss.
Any labs?
Is hepatic
Any labs?
Is hepatic lipidosis a possiblity here?
The liver really looks that
The liver really looks that way doesn’t it?
Hepatic enzymes are normal and the cat continues to eat although the owner is a little unsure how much.
Suzanne
I believe that FNA of
I believe that FNA of mesenteric LN in the cat often come back reactive- even if they have lymphoma. Maybe others can give their experience.
yeh thats’s a can of worms
yeh thats’s a can of worms question but if I have an fna like this then I keep it ready to go to CSU for PCR for LSA. I send all ours telecytology through sonopath and this, in addition to being sure my guy reads it, I and my techs have the slide in hand to scan more if needed by the pathologist or ready to drop fedex to CSU.
proactively ready for the scenario of maybe could be lsa if thats an issue. But combining my sonographic read wiht Larry’s cyto read we can combine the image sets and come to a concluison that makes sense and eventually send for PCR of need be.
Also the length to width (egg shape vs distroted golf ball shape) ratio is conserved which fits with reactive LN… so wihtout a shooping spree of bx we try to gather as many probables togetehr to reach an empirical concluison… occasionall these guys are dry FIP and MCT cases too and they don;t respond to empirical tx well or at least not long term. If small cell lsa or moderate/severe IBD then pred leukeran is as good as anythign. So empirical pred leukeran may be in order on some of these guys.
Lipidosis usually have
Lipidosis usually have elevated liver enzyme activity with ALP often higher than ALT. From the history and US, my bet would be on IBD. Would keep an eye on the lymph nodes – if lymph nodes will progressively enlarge.