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US and RAD – Cranioventral mediastinal soft tissue mass with bilateral pleural effusion and lung collapse in a 5 year old MN DSH cat

Case Study

US and RAD – Cranioventral mediastinal soft tissue mass with bilateral pleural effusion and lung collapse in a 5 year old MN DSH cat

This 12 year old MN DSH cat presented in respiratory distress

This 12 year old MN DSH cat presented in respiratory distress

Sonographic Differential Diagnosis

Thoracic mass, most likely of lymph node origin with lymphomatosis type
presentation.
Differentials include lymphoma, granulomatous disease such as FIP or other infectious
disease

Image Interpretation

US – The thorax in this patient presented a large amount of pleural effusion and a mixed, hypoechoic, cranial mediastinal mass that measured approximately 5.0 cm. No air entrapment was noted in the periphery of the mass, which would mean that this is likely of lymph node origin. The heart was volume contracted and displaced to the right. Ill defined pleural changes were noted with other lymph nodes that were mildly enlarged, hypoechoic and irregular. Thoracic rads – The chest volume is large, the intercostal spaces are widened, the diaphragmatic cupola reveals caudal displacement. A large soft tissue opaque cranioventral mediastinal mass effect is border effacing with the heart. The cardiac silhouette is obscured, however it appears to be displaced caudally. The carina reveals caudal displacement as well. The trachea is elevated by the ventrally located mass effect. Moderate bilateral pleural effusion is noted and recognized by rounded, retracted lung lobes, widening and soft tissue opacity of the pleural spaces and pleural fissure lines. The lung is dispaced caudally and laterally. The right cranial lobe presents a lobar alveolar pattern with an airbronchogram and trapped peripheral air.

DX

• Cranioventral mediastinal soft tissue mass • Moderate bilateral pleural effusion with lung collapse

Outcome

Possible differentials are cranioventral mediastinal lymphoma, thymoma, granulomatous disease such as FIP and ectopic thyroid/parathyroid carcinoma with paraneoplastic effusion – of which lymphoma appears to be the most likely. Ultrasound-guided FNA of the cranioventral mediastinal mass as well as pleurocentesis, cytospin and culture would all be indicated. Full abdominal sonogram is recommended to assess for similar infiltrative presentation in the abdomen.

Comments

no followup cytologies were done. Cat died a few days later.

Clinical Differential Diagnosis

R/O thoracic mass, lymphoma

Patient Information

Patient Name : Shadow Niles/CVC
Gender : Male, Neutered
Species : Feline
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 10_00091

Exam Finding

  • Respiratory Distress

Images

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