Case Study

Granular lymphocytic lymphoma diagnosed by FNA of thoracic masses in a 4 year old MN DSH cat

A 4-year-old MN DSH was presented for being not himself lately. Abnormalities on physical examination were increased respiratory effort and bilateral muffled heart sounds on auscultation. CBC, blood chemistry, and FeLV/FIV assay were all within normal limits. Thoracic radiographs showed pleural effusion with opacification of the heart. Approximately 80mls of turbid, hemorrhagic fluid was aspirated from both sides of the thorax, which on analysis was found to be an exudate. The patient was treated with Lasix and ampicillin.

A 4-year-old MN DSH was presented for being not himself lately. Abnormalities on physical examination were increased respiratory effort and bilateral muffled heart sounds on auscultation. CBC, blood chemistry, and FeLV/FIV assay were all within normal limits. Thoracic radiographs showed pleural effusion with opacification of the heart. Approximately 80mls of turbid, hemorrhagic fluid was aspirated from both sides of the thorax, which on analysis was found to be an exudate. The patient was treated with Lasix and ampicillin.

Sonographic Differential Diagnosis

Thoracic neoplasia and regional cranial mediastinal lymphadenopathy. Volume contracted heart.

Image Interpretation

The cardiac presentation was volume contracted with normal structural presentation towards the heart. Chamber sizes were normal. The contractility was normal as was the ventricular wall thicknesses. The left heart was volume contracted. The heart was displaced to the left. Two separate cranial right thoracic masses likely of lymph node origin were noted. One mass measured 4.2 cm (Videos 1 & 2) The other mass measured 2.5 cm (Video 3) and both were dramatically hypoechoic and heterogenic. These were sampled by fine-needle aspiration (Video 4).

DX

Granular Lymphocytic Lymphoma

Outcome

The masses were considered unresectable and chemotherapy was offered as an option. Referral to an oncologist was declined and the owner opted to place the patient on palliative treatment – prednisone and Lasix.