Case Study

Intestinal Mass Luminal Sampling Contaminant in a 15 year old FS DSH cat

This 15-year-old FS DSH cat was presented for progressive anorexia and weight loss. Physical examination revealed unkempt appearance and a marble sized palpable mid abdominal mass. Blood analysis revealed only mildly elevated amylase.

This 15-year-old FS DSH cat was presented for progressive anorexia and weight loss. Physical examination revealed unkempt appearance and a marble sized palpable mid abdominal mass. Blood analysis revealed only mildly elevated amylase.

DX

Intestinal mass

Sonographic Differential Diagnosis

These findings could represent emerging neoplasia with a complete disruption of wall layering. Severe, transmural inflammatory or granulomatous disease could also be considered.

Image Interpretation

Marked, circumferential, fairly symmetrical mural thickening is present within a segment of small bowel. The affected bowel wall is hypoechoic with near complete loss of wall layering. The fragmented, curvilinear echogenicity circumferentially located within the center of the wall likely represents an interrupted submucosal layer. Video demonstrates an erroneously guided FNA that samples both the intestinal wall and lumen causing bacterial contamination of the sample.Severe focal small bowel wall thickening with marked interruption of wall layering.

Outcome

The patient was lost to follow up.

Comments

The simple erroneous needle track was the likely cause of effective diagnosis in this case given that contaminating bacteria caused difficulty in the interpretation of the cells deriving from the affected portion of small intestine. Primary differentials of lymphoma, granulomatous disease/FIP or transmural enteritis could not be discerned owing to the presence of bacteria along with the intestinal wall cells. The needle should be angled on a way that it remains within the hypoechoic wall and not the lumen to avoid this issue.

Clinical Differential Diagnosis

GI pathology – Intestinal lymphoma, FIP, complicated inflammatory bowel disease with regional lymphadenopathy, foreign body obstruction, maldigestion. Pancreatic pathology – pancreatitis,