My colleague asked me to ultrasound a 14 year old M/N cat’s palpable mass in cranial abdomen so he could determine what the mass was. So…of course I did a full abdominal ultrasound 🙂
Hx:
– diagnosed with diabetes mellitus in 2011. Had been well controlled until Jan 2013 at which time it went into diabetic remission and insulin was discontinued.
– presented yesterday for inappetance and vomiting.
Clinical findings:
[videoembed id=6985]
[videoembed id=6986]
[videoembed id=6987]
My colleague asked me to ultrasound a 14 year old M/N cat’s palpable mass in cranial abdomen so he could determine what the mass was. So…of course I did a full abdominal ultrasound 🙂
Hx:
– diagnosed with diabetes mellitus in 2011. Had been well controlled until Jan 2013 at which time it went into diabetic remission and insulin was discontinued.
– presented yesterday for inappetance and vomiting.
Clinical findings:
– palpable mass in cranial abdomen; only abnormalities on labs – mild increase in globulin (10 above normal).
Radiographs:
– “indistinct” cranial abdomen (especially around the spleen/liver), otherwise NSF.
– 3cm x 3.5cm radiopaque mass just cranial to heart on lateral thorax.
Ultrasound:
– messentary in cranial abdomen quite hyperechoic
– mild free fluid in cranial abdomen
– bladder/kidneys/liver/adrenal/spleen WNLs (other than liver lobes slightly separated from fluid)
– ICCJ and nodes normal
– “palpable” mass corresponding to stomach +/- pancreas (see video x2)
– mass cranial to heart is anechoic with hyperechoic “capsule” (no CFW) (see video)
I am having trouble making out whether I am seeing abnormal stomach with inflammation around it, or normal stomach with abnormal pancreas around it…
Please enlighten me!
Thanks! 🙂
Comments
Jennifer what you are
Jennifer what you are describing is potentially a pancreatic carcinoma and carcinomatosis presentation that I often see in diabetics that go unregulated. It would fit with age and hx as well as the PE. I will wait for the video to upload to comment further but attaches is an example of pancreatic carcinoma that may fit what you are describing. This image is a pancreatic carcinoma in an older cat for example.
Jennifer what you are
Jennifer what you are describing is potentially a pancreatic carcinoma and carcinomatosis presentation that I often see in diabetics that go unregulated. It would fit with age and hx as well as the PE. I will wait for the video to upload to comment further but attaches is an example of pancreatic carcinoma that may fit what you are describing. This image is a pancreatic carcinoma in an older cat for example.
And to differentiate
And to differentiate pancreatic neoplasia from necrosis that can look very similar you need to fna the hypoechoic region, 22 or 25 g and push the body wall down to the lesion so there arent any structures in between.
And to differentiate
And to differentiate pancreatic neoplasia from necrosis that can look very similar you need to fna the hypoechoic region, 22 or 25 g and push the body wall down to the lesion so there arent any structures in between.
Sometimes these masses
Sometimes these masses mineralize which is typical of carcinoma like this geriatric cat.
Sometimes these masses
Sometimes these masses mineralize which is typical of carcinoma like this geriatric cat.
All of these lesions were
All of these lesions were palpable and had effusion associated with them..typically swoillen belly, roughened coat, spinal muscular atrophy and usually > 8 years and more often > 10 years and many diabetics ion the mix. I get called in for dysregulation of a new diabetic or past history of regulated diabetic with now dysregulation. Would be an interesting study to follow these out
All of these lesions were
All of these lesions were palpable and had effusion associated with them..typically swoillen belly, roughened coat, spinal muscular atrophy and usually > 8 years and more often > 10 years and many diabetics ion the mix. I get called in for dysregulation of a new diabetic or past history of regulated diabetic with now dysregulation. Would be an interesting study to follow these out
Thanks for the replies. I
Thanks for the replies. I have emailed the videos to Kelly, who will attach them shortly…
Thanks for the replies. I
Thanks for the replies. I have emailed the videos to Kelly, who will attach them shortly…
Now that the videos are up
Now that the videos are up jen this is a gastric or intestinal mass pushing the stomach out of view and non cardiogenic pleural effusion (The la/ao is normal so can;t be cardiac). This is typical for dual cavity lsa likely but fna of the hypoechoic wall away from the lumen should give a solid dx. You can tell that this is GI and likely stomach origin because the layers of the wall; are destroyed and you can follow the lumen of the stomach (or intestine) directly into the hypoechoic mass without separation. had this bneen a pancreatic mass like the ones i posted then the adjacent Gi would have had in tact layers that could be followed and counted (serosa, muscularis, sumucosa, mucosa and lumen). This is all defined well on the normals and age related changes dvd and the pathology cd series on the sonopath home page. In your image you see lumen with echogenic gas and mixed echogenic chyme that leads directly into the pathological hypoechoic tissue that used to be the GI wall that now had no layers. See attached gastric lymphoma case as a comparison. Cool case with bad outcome unfortunately.
Now that the videos are up
Now that the videos are up jen this is a gastric or intestinal mass pushing the stomach out of view and non cardiogenic pleural effusion (The la/ao is normal so can;t be cardiac). This is typical for dual cavity lsa likely but fna of the hypoechoic wall away from the lumen should give a solid dx. You can tell that this is GI and likely stomach origin because the layers of the wall; are destroyed and you can follow the lumen of the stomach (or intestine) directly into the hypoechoic mass without separation. had this bneen a pancreatic mass like the ones i posted then the adjacent Gi would have had in tact layers that could be followed and counted (serosa, muscularis, sumucosa, mucosa and lumen). This is all defined well on the normals and age related changes dvd and the pathology cd series on the sonopath home page. In your image you see lumen with echogenic gas and mixed echogenic chyme that leads directly into the pathological hypoechoic tissue that used to be the GI wall that now had no layers. See attached gastric lymphoma case as a comparison. Cool case with bad outcome unfortunately.
Thank you for the help with
Thank you for the help with the case. Unfortunately, the cat deteriorated over the weekend and was euthanized today (at home, so no necropsy done).
In the clips I provided, did you see any hint of pancreas? I couldn’t seem to find it anywhere, but figured it might be due to all the hyperechoic changes in the mesentery?
Thanks again
Jennifer
Thank you for the help with
Thank you for the help with the case. Unfortunately, the cat deteriorated over the weekend and was euthanized today (at home, so no necropsy done).
In the clips I provided, did you see any hint of pancreas? I couldn’t seem to find it anywhere, but figured it might be due to all the hyperechoic changes in the mesentery?
Thanks again
Jennifer
The tail end of video 3 at 2
The tail end of video 3 at 2 o’clock you can see some normal pancreas with duct in the middle. Unaffected by the gastric pathology.
The tail end of video 3 at 2
The tail end of video 3 at 2 o’clock you can see some normal pancreas with duct in the middle. Unaffected by the gastric pathology.