Case Of the Month

__________ in a 10-year old, Male Neutered DSH Cat: Our Case Of the Month

Extremely lethargic, mass effect in chest. Finished Pred, Gabapentin- no effect
Abnormal PE/Chem/CBC/UA Results: SDMA 17(bun, creat wnl)

Extremely lethargic, mass effect in chest. Finished Pred, Gabapentin- no effect
Abnormal PE/Chem/CBC/UA Results: SDMA 17(bun, creat wnl)

Chloe’s owner reported Chloe was “ADR” and hiding with the condition worsening over time. BW and U/A were normal. Chloe’s caudal lumbar area palpated uncomfortable. Rads revealed fused tail vertebrae, certainly a reason for moving slow and his heart appeared to be enlarged as well.

A double cavity ultrasound was ordered and findings confirmed the fused kidneys (which was previously diagnosed) and a pericardial diaphragmatic hernia was noted. Falciform fat was in the pericardial space. The heart did not appear to be dysfunctional owing to this congenital defect.

A few weeks later Chloe’s clinical signs worsened again, despite the pain medication, cortisone and antibiotics when Chloe presented again with dull mentation and not wanting to walk. He was not ataxic and no nystagmus noted. Dr. Summers noted that this must be something central affecting Chloe. He appeared painful – almost as if he had a migraine headache since he was squinting his eyes.

A CT was ordered at Blairstown, revealing a brain tumor. He was referred to Garden State Veterinary Specialists where brain surgery was performed, and found to be benign.

DX

The CT findings are compatible with mineralizing meningioma. Meningiomas in cats are typically benign and this one is in a favorable position for surgical removal. The recurrence rate

Outcome

He was referred to Garden State Veterinary Specialists where brain surgery was performed, and found to be benign.

Sonographic Differential Diagnosis

INTERPRETATION OF THE FINDINGS & FURTHER RECOMMENDATIONS

Both the renal fusion and the pericardial diaphragmatic hernia are congenital issues. I am concerned for the splenic enlargement however. Full urinary workup warranted If any weight loss is present, FNA of the spleen would be indicated.

COMPUTED TOMOGRAPHIC DIAGNOSIS
• Extra-axial intercranial neoplasia with severe mass effect onto the ventricular system, cerebral
hemispheres, diencephalon, and cerebellum.
• Foraminal herniation of the cerebellum.
• Right otitis externa.

Image Interpretation

ULTRASONOGRAPHIC FINDINGS

• Stable pericardial diaphragmatic hernia, no cardiac dysfunction

• Congenital renal fusion with mild to moderate degenerative changes

• Enlarged spleen

CARDIAC PRESENTATION

The echocardiogram in this patient demonstrated normal left atrial size based on 3 separate LA measurements. The cranial and caudal mitral valve leaflets presented normal linear structure and kinetics. The left ventricle presented normal thicknesses with linear contour and was not dilated nor restricted. The myocardium presented normal echogenicity without subjective evidence of significant fibrotic or ischemic disease. Contractility of the ventricular walls was adequate and in normal range for this patient evidenced by the fractional shortening measurement and subjective evaluation of the different regions and angles of the myocardium. The left ventricular outflow tract demonstrated normal laminar flow and subjective structural integrity. The right atrium and auricle revealed normal size, structure and content. No evidence of masses was noted or chamber overload. Tricuspid valvular assessment demonstrated adequate linear morphology and kinetics.

The right ventricle was of normal size (1/3 diameter of LV), chordae structure, myocardial echogenicity and thickness. Pulmonic tract assessment revealed normal valve structure, laminar flow, and diameter (approx.1:1 pa/ao ratio). A pericardial diaphragmatic hernia was noted in this patient. Falciform fat was in the pericardial space. The heart does not appear to be dysfunctional owing to the congenital defect.

COMPUTED TOMOGRAPHIC FINDINGS

The nasal cavity presents the expected aerated spaces between thin & even conchae and turbinates with smooth mucosal lining.

Both temporomandibular joints present congruent joint spaces with even subchondral bone surfaces and are considered within normal limits.

The tympanic bullae are aerated, the mucosal lining is not seen, and the bony wall is smooth and thin. A mild amount of hypoattenuating material is seen within the medial aspect of the right external auditory meatus.

The CT study reveals an ovoid irregular shaped extra-axial mass with multifocal mineralization and broad base to the cerebral falx as well as the left parietal bone within the cranial fossa. Left parietal bone hyperostosis is noted. The mass measures approximately 2.0 cm in length and 1.5 cm in height and width each. There is moderate nonuniform contrast enhancement noted throughout the mass. A severe mass effect is seen onto the underlying cerebral hemispheres with severe rightward shift of the cerebral falx. Dural tears are seen along the cerebral falx and left parietal meninges. Both lateral ventricles and the third ventricle are compressed. There is a mass effect onto the diencephalon and cranial aspect of the cerebellum. Caudal foraminal herniation of the cerebellum is seen.

The submandibular and medial retropharyngeal lymph nodes are small and elongated with a normal short-to-long-axis-ratio of < 0.5. The attenuation and contrast enhancement pattern are uniform.

Patient Information

Patient Name : Chloe Petry

Gender : Male, Neutered

Species : Feline

Status : Complete