Pancreatic necrosis and liver carcinoma in a 15 year old MN DMH cat

Case Study

Pancreatic necrosis and liver carcinoma in a 15 year old MN DMH cat

A 15-year-old MN DMH cat was presented for chronic diarrhea, hyperthyroid, dehydration, otitis externa, and periodontal disease. The CBC was markedly normal with blood chemistry revealing an elevated ALT (154,) elevated SAP (109,) hyperT4 (>10,). An IDEXX feline diarrhea panel was negative for virus, parasites, & bacteria.

A 15-year-old MN DMH cat was presented for chronic diarrhea, hyperthyroid, dehydration, otitis externa, and periodontal disease. The CBC was markedly normal with blood chemistry revealing an elevated ALT (154,) elevated SAP (109,) hyperT4 (>10,). An IDEXX feline diarrhea panel was negative for virus, parasites, & bacteria.

Sonographic Differential Diagnosis

Aggressive appearing left pancreatic nodules/pancreatitis presentation extending into regional omental inflammation. Nodular and swollen liver. Suspect infiltrative disease involving the pancreas and liver. Potential for underlying nodular hyperplasia and pancreatitis. Guarded prognosis.

Image Interpretation

The pancreas was prominent and mildly hypoechoic. Caudal aspect of the left limb of the pancreas was hypoechoic and irregular. It measured 0.86 cm with minor, hyperechoic reactive fat pattern. Mixed, echogenic changes were noted in the pancreatic body with prominent and mildly irregular pancreatic duct with coarse architecture and mixed, hypoechoic pancreatic tissue with reactive surrounding fat. The liver presented heterogenous parenchymal changes with an isoechoic to mixed echogenic nodule in the deep left liver that measured 1.59 cm. The right lateral liver also presented hypoechoic nodules and minor loss of detail that measured 0.57-0.58 cm. Hyperechoic nodules were also noted in the left medial liver. FNAs of the liver were performed without significant complications. Slight free fluid was noted post sampling. This is an expected variant. The gallbladder and common bile duct were unremarkable.

DX

Pancreas: severe necrotic material, no pancreatic cells. Liver: carcinoma.

Outcome

No further outcome at this time.

Clinical Differential Diagnosis

Liver clinical signs- cholangio-hepatitis complex, lipidosis, neoplasia, bacterial/viral hepatitis, toxins.
G.I. clinical signs- diarrhea, IBD, dietary hypersensitivity. Neoplasia. Uncontrolled hyperthyroidism.

Sampling

FNA of pancreas was severe necrotic material, no pancreatic tissue. FNA of liver was carcinoma,

Patient Information

Patient Name : Dusty H
Gender : Male, Neutered
Species : Feline
Type of Imaging : Ultrasound
Book : yes
Status : Complete
Liz Wuz Here : Yes
Code : 05_00104

Clinical Signs

  • Dehydration
  • Diarrhea

Exam Finding

  • Otitis externa

Images

PancreasDustyHeatonFeDSH13yoMNPancreatitislivercarcinoma4_08262012113649PancreasDustyHeatonFeDSH13yoMNPancreatitislivercarcinoma3_08262012113705unnamed2_11172012014147PancreasDustyHeatonFeDSH13yoMNPancreatitislivercarcinoma1_08262012113720PancreasDustyHeatonFeDSH13yoMNPancreatitislivercarcinoma2_08262012113736unnamed_11172012014109

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • ALT (SGPT), High
  • Hyperthyroidism

Clinical Signs

  • Dehydration
  • Diarrhea
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