Intestinal Neoplasia

Case Of the Month

On Any Given Sunday: Meeting Sonographic Criteria For Intestinal Neoplasia But Neoplasia Doesn’t Win The Game. This is why we play the game…to ensure we don’t do “histopathological ultrasound” and not just call it neoplasia.
Patient imaged by Andi Parkinson RDMS and medical management by Dr. Pam Nesbitt, Surgery By Dr. Joe Zulty, Essex Middle River Veterinary Center, Baltimore, MD, USA.

Sonogram: (G.I., 7/28/10): “Chloe”

On Any Given Sunday: Meeting Sonographic Criteria For Intestinal Neoplasia But Neoplasia Doesn’t Win The Game. This is why we play the game…to ensure we don’t do “histopathological ultrasound” and not just call it neoplasia.
Patient imaged by Andi Parkinson RDMS and medical management by Dr. Pam Nesbitt, Surgery By Dr. Joe Zulty, Essex Middle River Veterinary Center, Baltimore, MD, USA.

Sonogram: (G.I., 7/28/10): “Chloe”

History: (Kelly Vazquez,CVT): A 12-year-old FS Dachshund was presented at an emergency facility for intermittent vomiting and diarrhea lasting several weeks. The only obvious abnormality on physical examination was lethargy. She was treated Famotadine, Metronidazole, and discharged with a bland diet. At follow-up examination the following day at the RDVM, the owner reported that the patient had vomited twice and was having uncontrollable diarrhea. CBC and blood chemistry showed neutrophilia, lymphocytopenia, eosinopenia, elevated ALP activity, elevated CK, hyperamylasemia, and low TCO2. cPL was 173. Abdominal radiographs showed some loss of density in the cranial abdomen. The patient was treated with IV fluids, Metronidazole, Ampicillin, and Cerenia.

Outcome

The patient had been recommended for immediate exploratory surgery with a plasma transfusion as well as assessment for pituitary dependent Cushing’s disease. Intra-operative ultrasound was also offered to determine further definition of healthy bowel. The patient underwent an exploratory laparotomy, which resulted in removal of the cecum, 2 inches of colon, and 2 inches of small intestine. Post-operative CBC only showed a low MCHC. Post surgery the patient developed multiple purulent skin lesions that lasted for approximately 2 weeks post-operatively and did not resolve despite treatment with Simplicef or Amoxicillin. Biopsy of these lesions revealed chronic neutrophilic and lympho-histiocytic perivascular dermatitis ascribed to the intestinal lesions. Several weeks after surgery the owner reported that the patient was doing very well.

Comments

Special thanks to Dr. Zulty & Nesbitt for the virtual referral of this case by means of Andi Parkinson, RDMS of (Intrapet Imaging) and Chloe’s successful management.

Clinical Differential Diagnosis

(Remo Lobetti PhD, DECVIM):

GI tract – IBD, neoplasia, infection (bacterial/protozoa/fungal), partial obstruction
Pancreas – pancreatitis, neoplasia
Peritonitis

Sampling

(Nesbitt DVM): Full-thickness surgical biopsies of both the cecum and lymph node revealed pyogranulomatous mural typhlitis and lymphadenitis, respectively.

Sonographic Differential Diagnosis

(Lindquist DMV, DABVP): Perforating ileum at the ileocecal junction. Loss of detail, excessive wall thickness and lack of peristalsis combines to meet neoplastic criteria such as intestinal lymphoma, mast cell disease, or carcinoma. Complicated inflammatory disease (IBD, bacterial based enteritis), bowel infarction, and/or spontaneous perforation should also be considered.

Image Interpretation

(Lindquist DMV, DABVP)

Patient Information

Gender : Female, Spayed
Species : Canine
Status : Complete

Images

COM_1012_01COM_1012_02COM_1012_03
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