Case Of the Month

Case Study of the Month June 2013

Imaging by Lindquist DMV, DABVP, Cert. IVUSS.

Sonogram (Thorax): Snowy

A 13-year-old hyperthyroid SF DSH was presented for “not doing right” and anorexia. Abnormalities on CBC and serum biochemistry were left shift leukocytosis and elevated ALT activity (698). The patient was treated symptomatically with Cerenia, Covenia, Enrofloxacin, and Buprenex.

Imaging by Lindquist DMV, DABVP, Cert. IVUSS.

Sonogram (Thorax): Snowy

Outcome

Owners declined further diagnostics. The owners elected humane euthanasia based on the poor prognosis and did not want to pursue chemotherapy.

Comments

Special thanks to Dr. Jennifer Louks and Dr. Cheri Smith and staff at Whippany Animal Hospital, Whippany, NJ, USA (www.whippanyvethospital.com) for their excellent management of this case.

Clinical Differential Diagnosis

Uncontrolled hyperthyroidism
Liver – cholangio-hepatitis complex, neoplasia, toxins, infectious (viral/bacterial)
Cardiac hypertrophy secondary to hyperthyroidism
Neoplasia – thoracic cavity, abdomen

Image Interpretation

Lung mass with pleural effusion. Thoracic carcinoma suspected extending to the heart base and enveloping the thoracic duct/thoracic vena cava region. Secondary pulmonary hypertension and passive congestion in the liver.

Oncology consultation after pleurocentesis with immediate cytospin and slide preparation is recommended in order to preserve cell integrity. Poor prognosis. CT or exploratory thoracotomy was also offered.

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