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Pancreatic neutrophilic and macrophagic inflammation in an 11 year old FS DSH cat

Case Study

Pancreatic neutrophilic and macrophagic inflammation in an 11 year old FS DSH cat

This 11-year-old indoor/outdoor FS DSH cat presented for lethargy and anorexia. The physical exam revealed a painful mid cranial abdomen and moderate pyrexia. The CBC revealed moderate neutrophilic leukocytosis with a left shift, while blood chemistry analysis revealed moderately elevated total protein and globulins with severe hyperglycemia. The elevation in total protein and globulins and leukocytoses were persistent on repeat analysis over a 48 hour period. The urinalysis revealed 3+ glucosuria, and moderately elevated WBC and RBC with no reported bacteriuria.

This 11-year-old indoor/outdoor FS DSH cat presented for lethargy and anorexia. The physical exam revealed a painful mid cranial abdomen and moderate pyrexia. The CBC revealed moderate neutrophilic leukocytosis with a left shift, while blood chemistry analysis revealed moderately elevated total protein and globulins with severe hyperglycemia. The elevation in total protein and globulins and leukocytoses were persistent on repeat analysis over a 48 hour period. The urinalysis revealed 3+ glucosuria, and moderately elevated WBC and RBC with no reported bacteriuria.

Sonographic Differential Diagnosis

Moderate to severe pancreatitis with adjacent peritoneal inflammation. The significance of the pancreatic duct dilation is dubious, given the age of the animal and could be incidental or secondary to active pancreatic inflammation.

Image Interpretation

A moderately enlarged and hypoechoic pancreas is present. The pancreas is bordered by markedly echogenic mesenteric and omental fat. Mild dilation of the pancreatic duct is also noted.

DX

Pancreatic mixed neutrophilic and macrophagic inflammation with high cellularity.

Outcome

The patient responded partially over the following 6 weeks to hospitalization and then outpatient fluid and supportive therapy. Blood glucose levels were persistently uncontrollable and the owner selected humane euthanasia 7 weeks post sonogram. Underlying pancreatic neoplasia could not be completely ruled out based on cytology alone in this case.

Comments

No video is available on this patient.

Clinical Differential Diagnosis

Diabetes either primary or secondary to pancreatitis. Pancreas: pancreatitis, infectious disease, sepsis, lymphoma or other neoplasia, pancreatitis. Kidney: pyelonephritis.

Sampling

22 and 25-gauge US guided FNA of the pancreas revealed mixed neutrophilic and macrophagic inflammation with high cellularity. Concurrent liver FNA revealed similar suppurative inflammation with high cellularity. Biopsy was not performed due to poor clinical condition at the time of the exam.

Patient Information

Patient Name : Pirate M
Gender : Female, Spayed
Species : Feline
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 05_00016

Clinical Signs

  • Anorexia
  • Lethargy

Exam Finding

  • Abdominal Pain
  • Fever

Images

Pirate_2_11232009061236Pirate_1_11232009061216

Blood Chemistry

  • Globulin, High
  • Glucose, High
  • Total Protein, High

CBC

  • Left Shift
  • Neutrophils, High
  • WBC, High

Clinical Signs

  • Anorexia
  • Lethargy

Urinalysi

  • Blood Present
  • Isosthenuria Present
  • WBCs Present