Case Of the Month

Pancreas & Intestine

Zooming In On Pancreas & Intestine. Following the lines and losing the curvilinear detail of an organ system. Squeezing the diagnosis out of the sonogram and needle alone. Welcome to our current state of pet owner economy.
Imaging performed by Doug Casey DVM, DABVP, English Bay Ultrasound, Vancouver, BC, Canada. Interpretation by Eric Lindquist DMV, DABVP.

Sonogram: “Mickey”

History: (Vasquez RVT): A 16-year-old MN DSH cat presented for anorexia, vomiting, and urinary calculi. Radiographs showed a mass caudal to the stomach. Bloodwork and urinalysis were not performed owing to economic concerns so the patient went right to ultrasound, which is not ideal, but strictly the choice of the owner.

Outcome

Upon opening the midline, tumor metastasis were discovered throughout the entire peritoneal surface, a 5-6 cm mass was seen in the intestines, and the pancreas was massively invaded with tumor, possibly primary.

Clinical Differential Diagnosis

(Remo Lobetti PhD, DECVIM):

Neoplasia – lymphoma/GI tract/pancreas/kidney
Cyst
Hydronephrosis

Sampling

Prior to surgery an US-guided FNA was highly suggestive for adenocarcinoma. Post mortem biopsies confirmed pancreatic carcinoma deriving from nodular hyperplasia and adenoma with contiguous spread to the duodenum and peritoneum; pancreatic carcinomatosis.

Sonographic Differential Diagnosis

(Lindquist DMV, DABVP): Owing to the dramatic loss of structure within the small intestine as well as the pancreas, intestinal +/- pancreatic neoplasia is suspected. Aggressive inflammatory or granulomatous disease is less likely. Primary concerns are carcinoma, lymphoma, mast cell disease, or dry form F.I.P involving the small intestine and/or pancreas.