Case Study

Chylous effusion and possible small cell lymphoma in a 3 year old FS Pit Bull Terrier mix dog

A 3-year-old FS Pitbull Terrier mix was presented for weight loss. The only significant abnormality on physical examination was pale mucous membranes. CBC and blood chemistry showed leukopenia, thrombocytopenia, lymphopenia, hypoproteinemia, hypoalbuminemia, elevated liver enzyme activity, hyperbilirubinemia, hypocalcemia, hypokalemia, hypocholesterolemia, and hyperamylasemia. Lyme, Ehrlichia canis, Rocky Mountain Spotted Fever and leptospirosis results were all negative. Random cortisol was elevated. The patient was being treated with I.V.

Sonographic Differential Diagnosis

Pleural effusion was aspirated via thoracocentesis and submitted for cytospin. Multicentric neoplasia is suspected with a minor possibility of vasculitis.

Image Interpretation

Minor pericardial and pleural effusion was noted with lung consolidation in the right cranial lobe. The diaphragm was visualized without interruption.

DX

Chylous effusion with the possibility of small cell lymphoma.

Outcome

Recheck blood work showed anemia, azotemia, elevated BUN/Creatinine ratio, progressive leukopenia, thrombocytopenia, lymphopenia, hypoproteinemia, hypoalbuminemia, and elevated liver enzyme activity. The patient was treated with doxycycline and continued with fluid therapy. Owner cooperation for further diagnostic workup was problematic in this case. The patient was lost to follow-up. Abdominal sonogram, bone marrow biopsy and PARR testing for lymphoma would have been the next appropriate diagnostic steps.

Clinical Differential Diagnosis

Bone marrow failure – infectious disease, immune-mediated disease, toxins, neoplasia. Hypoalbuminemia – liver disease, GI loss, glomerulonephritis. Neoplasia.

Sampling

Cytology from an US-guided FNA of the pleural effusion revealed predominantly mixed lymphocyte population, compatible with chylous effusion with the possibility of small cell lymphoma.