- 3 year old cat that was having cardiac scan as had episodes of retch/cough and patchy pulmonary infiltrates on xray
- Cardiac scan normal, suspect pneumonia, responding to antibiotics
- Dramatic nodules in liver seen when performing cardiac scan, rest of abdominal scan unremarkable
- Appetite, weight, form all normal, no V+/D+
- Haem low MCV, biochem pending
- I have never seen this pattern in a cat before, any idea of what this might be?
- 3 year old cat that was having cardiac scan as had episodes of retch/cough and patchy pulmonary infiltrates on xray
- Cardiac scan normal, suspect pneumonia, responding to antibiotics
- Dramatic nodules in liver seen when performing cardiac scan, rest of abdominal scan unremarkable
- Appetite, weight, form all normal, no V+/D+
- Haem low MCV, biochem pending
- I have never seen this pattern in a cat before, any idea of what this might be?
Comments
Mutifocal areas of
Mutifocal areas of hyperplasia, fibrosis or calcification can look like this. I suppose small chronic infarctions are also possible. Some of the nodules seem to have mild shadowing associated with them.
I suppose you could FNA the liver for cytology to see what you get pending the chemistry panel. If no clinical signs associated with liver disease or elevated liver enzymes, they may just be incidental even though they are dramatic to see in ultrasound.
The liver enzymes are
The liver enzymes are elevated ALT moderately and ALP mildly, BA 18 (resting), bilirubin ok, proteins ok, mild anaemia. Will hopefully go for tru-cut biopsy.
Are you happy using ultrasound guided tru-cut biopsies in cats?
The elevated ALT over ALP
The elevated ALT over ALP suggests an inflammatory process.
Personally, I get nervous using Tru cuts in cats. Theres just not a lot of room to work with. For example, the liver in some images is about 1 cm depth. If you use a standard 20 mm (extension) needle for the sample, it will put you at about 3 cm depth dpending on the angle which would be pretty deep in the liver…with more risk to hit something you didn’t intend to hit.
Larger needles are useful to the pathologist for sample size but may cause more bleeding (larger sample size per body weight) while smaller needles may run the risk of lack of sample quality.
Regardless, I have done them in cats and generally had good results with diagnosis. I think the argument goes both ways as far as avoiding open laparotomy. Some people may argue that open lap biopsies provide the change to get other biopsies such as GI and pancreas to rule out other pathologies often seen with inflammatory liver diseases in cats.
I will add that if a biopsy
I will add that if a biopsy is done, I would pretreat with Vit K for 24-48 hours prior to the biopsy and 2-3 days after biopsy.
Without weight loss i doubt
Without weight loss i doubt the nodules are pathological possibly secondary to some metabolic +/- issue? They have the consistency of lipogranulomas. 25g fna should define well enough I would think. I think the need to core bx vs fna largely depends on the cytologist you are using. I personally core bx much less than before and mainly when looking for structure like in a cholangitis case. But when looking for lsa or lipidosis or assessing inflammatory cell type confirmation then fna is usually adequate with our telecytology.