Large spleen in senior cat
– 10 yo MN DSH, obese, elevated liver enzymes (ALP 248>59, ALT 419>158) on wellness labwork. T4 pending.
– Doing well at home.
– Gallop sound, dilated La/AO on echo (I sent the echo to you today), thickened Left ventricular walls, HCM suspected.
– Abdo u/s: all WNL except for a diffusely enlarged spleen, 1.9 cm wide, just before the area where it folds: hematopoiesis vs diffuse neoplasia (MCT/lymphoma) vs other.
Large spleen in senior cat
– 10 yo MN DSH, obese, elevated liver enzymes (ALP 248>59, ALT 419>158) on wellness labwork. T4 pending.
– Doing well at home.
– Gallop sound, dilated La/AO on echo (I sent the echo to you today), thickened Left ventricular walls, HCM suspected.
– Abdo u/s: all WNL except for a diffusely enlarged spleen, 1.9 cm wide, just before the area where it folds: hematopoiesis vs diffuse neoplasia (MCT/lymphoma) vs other.
– Needs splenic FNA but the heart is not great, and there is no way I am poking his spleen without sedation.
What do you think of the spleen?
Thank you!
Julie
Comments
Round cell spleens usually
Round cell spleens usually mean “ADR” cat with weight loss. On occasion splenic rotation and secondary stabilization with regional swelling can occur in dogs and cats and this may be one of them. Sometimes it mineralizes at the fold as well over time. Saw one in a german shepherd yesterday. We are imaging in a 2 dimensional plane in a 3 dimensional potential splenic rotation. 25g fna here warranted of course but dont be surprised if benign hyperplasia or similar comes back.
Thank you, Eric! Good to
Thank you, Eric! Good to know! I’d be happy with benign hyperplasia. The cat is fat and sassy, no weight loss or any issues.
Majority of cats will
Majority of cats will tolerate FNA spleen without sedation using 25 G needle. As liver enzymes also elevated would FNA the liver as well as could be dealing with lymphoma.
Thanks Dr. Lobetti! Here is
Thanks Dr. Lobetti! Here is the update, his T4 was finally run and it was really high. We will recheck his liver values in a month.
I am a big chicken and sedate all my FNA. I do mobile u/s and I am not there to monitor after the poke, so I want them really still when I put a needle in it.
He is a B2 HCM, do you think his spleen could be congested because of the heart disease?
Julie
A possiblity but no other
A possiblity but no other signs of congestion. Something to considered would be as a result of the hyperthryroidism as there are few isolated reports in the human literature of splenomegaly associated with a hyperthryroid state. Would be interesting to see what happens with the spleen once the hyperthryoidism is controlled.
That’s interesting! I will
That’s interesting! I will let you know if I get a chance to recheck that spleen!
Thank you.
Update. Patient is doing
Update. Patient is doing great since started on methimazole and heart meds for HCM (atenolol, enalapril). Liver values back to normal. Recheck u/s delayed since he is doing well.