Case Study

Pancreatic carcinomatosis in a 16 year old MN DSH cat

A 16 year old MN DSH with a history of prior subtotal colectomy, liver adenoma, and IBD was presented for ascites and anemia. Abnormalities on CBC were anemia, neutrophilia, and monocytosis. Serum biochemistry was within normal limits.

A 16 year old MN DSH with a history of prior subtotal colectomy, liver adenoma, and IBD was presented for ascites and anemia. Abnormalities on CBC were anemia, neutrophilia, and monocytosis. Serum biochemistry was within normal limits.

DX

Cytology of the abdominal effusion revealed neoplastic effusion.

Sonographic Differential Diagnosis

Carcinomatosis type presentation. This is likely deriving from the pancreas. Thickened intestines. Free fluid. This is consistent with carcinomatosis or similar disease. Potential FIP. However, given the effusion analysis, this presentation would be most consistent with carcinomatosis. The mixed hypoechoic pancreatic changes along with nodular omentum and free fluid would be most consistent with carcinomatosis especially given the volume contraction of the spleen and normal hepatic vasculature. This eliminates possibility of hepatic congestion especially because the albumin levels are normal and oncotic pressures would be sustained then lymphatic obstruction and carcinomatosis, lymphomatosis type presentation is most likely.

Image Interpretation

The abdomen in this patient presented a moderate amount of mildly echogenic free fluid, nodular omentum and hypoechoic tissue. This is consistent with irregular pancreas in multiple views. Some small intestinal wall thickened was also noted. Hypoechoic cystic changes in the region of the pancreas may represent mesenteric root lymph node or potentially abscessing pancreatic lesion. Areas of the hypoechoic, nodular pancreatic changes appear to extend into a coalesced 2.0 cm mass with surrounding nodular omentum. This created a coalesced ball of omentum.

Outcome

The patient was lost to follow up.

Clinical Differential Diagnosis

Modified transudate – neoplasia, cardiac disease, hepatic disease. Septic exudate. Non-septic exudate – FIP, bile, urine, inflammatory reaction from pancreatitis.