Case Study

CT – Triaditis with multi-organ involvement suggesting round cell neoplasia in a 3 year old MN DSH cat with paraparesis

This 3 year old MN DSH cat presented with acute ambulatory paraparesis in the hind limbs.

DX

• Severe Nephropathy • Evidence of triaditis: cholangiohepatitis, pancreatitis, duodenitis • Splenomegaly • Lymphadenomeagly cranial mediastinal lymph nodes

Image Interpretation

CT of the spine/abomen/thorax- There is moderate enlargement of the cranial mediastinal lymph nodes increased short-to-long axis ratio > 0.5. The sternal lymph node presents moderate symmetric enlargement. Both kidneys present with a markedly irregular shape and surface. Multiple protruding and parenchymal nodules with varying degress of contrast enhancement are seen. The extrahepatic biliary ducts, the cystic and common bile duct present markedly dilated as well as the pancreatic duct. A mechanical cause for an obstruction is not detected. The duodenal wall presents mild generalized thickening level with the papilla. The spleen is enlarged and extends to the level of urinary bladder. The liver shows a homogeneous parenchymal contrast enhancement and presents mid generalized enlargement.

Outcome

The combination of the findings is highly suspicious for round cell neoplasia (lymphoma) or feline infectious peritonitis (dry FIP) with involvement of both kidneys, and the cranial mediastinal lymph nodes and triaditis.
An ultrasound examination – if not performed yet – is recommended including the cranial mediastinum (best cranial approach) to visualize and sample cranial mediastinal lymph nodes, liver, spleen and if possible kidneys. Laboratory workup for pancreatitis/hepatitis/FIP.

An underlying myelopathy could not be identified. However for both entities – lymphoma and FIP – involvement of the central nervous system is common in cats. If the results of the abdominal ultrasound/sampling & laboratory workup remain inconclusive an MRI may be considered for further definition.