Case Study

03_00168 Molly B Lymphocytic infiltration, liver splenic lymphoma

A 7-year-old F intact DSH was presented for the evaluation of dyspnea. The physical exam revealed muffled heart sounds and a thoracocentesis was performed bilaterally. One hundred milliliters (ml) of fluid was obtained from the right hemithorax and 35 ml from the left. Fluid analysis revealed cellularity to be moderate to high and RBC 100,000. Blood chemistry was performed and revealed the following abnormalities: CK 1359, albumin 3.4 g/l, direct bilirubin 0.2, and glucose 158 mg/dl.

A 7-year-old F intact DSH was presented for the evaluation of dyspnea. The physical exam revealed muffled heart sounds and a thoracocentesis was performed bilaterally. One hundred milliliters (ml) of fluid was obtained from the right hemithorax and 35 ml from the left. Fluid analysis revealed cellularity to be moderate to high and RBC 100,000. Blood chemistry was performed and revealed the following abnormalities: CK 1359, albumin 3.4 g/l, direct bilirubin 0.2, and glucose 158 mg/dl.

Sonographic Differential Diagnosis

Splenomegaly and hypoechoic liver with slight periportal lymphadenopathy in light of non cardiogenic pleural effusion (left heart was volume contracted in this patient)suggests a dual cavity neoplastic process such as lymphoma. Systemic infectious disease less likely.

Image Interpretation

The spleen is uniformly enlarged and micronodular suggestive for an infiltrative process or potentially splenitis. The liver is mildly swollen and hypoechoic with slight periportal lymphadenopathy evidenced by surrounding color flow of the portal vein.

DX

Liver: lymphocytic infiltration, vacuolar hepatopathy, biliary stasis. Spleen:suggestive of lymphoma

Outcome

The owners elected to treat the cat with chemotherapy, however she became fractious and the owners were unable to medicate her and therefore unable to keep her comfortable. Humane euthanasia was elected 2 weeks after the diagnosis.

Clinical Differential Diagnosis

Heart failure due to hypertrophic, restrictive, unclassified or possibly dilated cardiomyopathy, idiopathic chylothorax (not enough information with above results to rule out chylothorax,) neoplasia (primary or metastatic) causing lymphatic obstruction (lymphoma, adenocarcinoma,) previous trauma which may have damaged the thoracic duct, thereby affecting lymphatic drainage.

Sampling

Fine needle aspirates of the spleen and liver were performed. Cytology results of the liver were suggestive of lymphocytic infiltration with probable mild vacuolar hepatopathy and biliary stasis. The spleen was suggestive of lymphoma.