Case Study

03_00190 Shades A Hepatic carcinoma

A 9-year-old MN DSH was presented for evaluation of ascites. On physical examination a distended abdomen and weight loss was evident. Fluid analysis revealed a moderate neutrophilic exudate – suspected bacterial sepsis. CBC showed neutrophilia, monocytosis, and mild anemia whereas serum chemistry was within normal limits.

A 9-year-old MN DSH was presented for evaluation of ascites. On physical examination a distended abdomen and weight loss was evident. Fluid analysis revealed a moderate neutrophilic exudate – suspected bacterial sepsis. CBC showed neutrophilia, monocytosis, and mild anemia whereas serum chemistry was within normal limits.

DX

Liver: carcinoma (suspected metastatic.) Pancreas: carcinoma.

Sonographic Differential Diagnosis

Bi-cavity effusion. Nodular pancreatic and hepatic changes. This is highly suggestive for dual cavity neoplasia such as carcinomatosis or possible feline infectious peritonitis. An abdominocentesis with cytospin and immediate slide preparation would be recommended for a definitive diagnosis. Alternatively, fine-needle aspirates of the pancreas and liver nodules would be warranted. Very poor long term prognosis.

Image Interpretation

The abdomen in this patient presented moderate amount of echogenic free fluid. Multiple heterogenous nodular changes were noted with hypoechoic and hyperechoic throughout the liver. This is suggestive for metastatic event. Some internal structure deviation was noted. The deep right liver revealed a collapsed gallbladder with surrounding parenchymal nodular changes with impingement upon the gallbladder. The pancreatic region revealed multiple nodular hypoechoic changes with irregular surrounding omentum.

Outcome

The patient was humanely euthanized.

Clinical Differential Diagnosis

Bacterial peritonitis. Feline infectious peritonitis. Neoplasia – intra-abdominal, liver, spleen, kidney, pancreas, mesenteric lymph node. Chemical – urine, bile.