Question:   Can all of these lesions (liver, spleen, kidney, prostate, lungs, fat) have fungal (coccidiomycoides) or neoplasia (hemangiosarcoma)? Is there intestinal involvement? Have you seen this pattern before? Unfortunately the rDVM is not wanting to pursue FNA at this time.  If fungal titer comes back + then maybe so to rule out co-morbidities.

Any other comments?   Missed any images that would have been helpful?

Thanks
Tom

EL: Hi Tom, the only fungal disease that occurs in NJ is foot fungus:) But i saw some valley fever in so cal and the general theme of fungal disease and pythiosis for that matter is it looks just like metastatic cancer so you cant tell without a needle or 2 and yes I can keep fungal high on the diff with all these lesions. I would really push the owner to do fna as all this may be treatable even if the spleen and kidney is blowing apart on this guy. I do not see any GI involvement structurally and the anechoic splenic masses can be just subcapsular bleeds.

In fact, see one of Marty’s Henderson’s cases in 2010. Check out this case of the month from then as it is similar to yours just not as progressed. All old cases of the month are on sonopath with the link just below current one.

Eric Lindquist DMV (Italy) DABVP
Cert./Pres. IVUSS
Director SE NJ Mobile Associates
Founder/CEO: SonoPath.com