Case Study

Omental steatitis in a 12 year old FS Rhodesian Ridgeback

A 12-year-old FS Rhodesian Ridgeback dog with history of frequent urinary tract infections, hypothyroidism (on Soloxine), and urinary incontinence (on Proin), was presented for a recheck T-4. Abnormalities on physical examination were tachypnea, and a grade II-III/VI heart murmur. CBC was within normal limits. The only abnormality on blood chemistry was elevated ALP activity. T-4 was elevated and parvovirus vaccinal titer was >1:5. Bile acids results and liver function results were within normal limits. The patient was placed on Primor pending results of urinalysis, which showed leukocyturia, bacteria (cocci and rods 1+), and few calcium oxalate crystals. Urine culture yielded no growth. Recheck urinalysis 10 days later was within normal limits but the owner reported a decreased appetite.

Sonographic Differential Diagnosis

Caudal abdominal mass of omental, pancreatic or intestinal origin appears resectable.

Image Interpretation

A 4.5 cm caudal abdominal mass which appeared well circumscribed was located adjacent to the caudal aspect of the left pancreatic limb. The origin of this mass could not be overtly ascertained. It could also be of small intestinal origin.

DX

Omental and secondary mass revealed omental steatitis

Outcome

The patient underwent exploratory surgery with liver biopsies, mass removal, and recovered without event. The patient was treated with Baytril, Flagyl, and discharged with L/D diet. At sutures out appointment, the patient was found to be doing well, with incision healed nicely. A recheck T-4 was within normal range. Abnormalities on follow-up urinalysis were proteinuria (1+), hematuria (2+), leukocyturis (4-10), high RBC (4-10), and bacteria (rods 4+). Urine microalbumin was elevated. Urine culture yielded growth of Escherichia Coli. The patient was treated with Simplicef.

Comments

Steatitis is inflammation of fat. It is usually referring to the reactive or inflamed omentum that may be multifocal but is a term that is separate from fattu inflammation associated wiht pancreatitis or enteritis. In this case there was a focal granuloma type presentation of steatities. On ultrasound its typically mesentery that is ill defined losing its linear infrastructure and becomes “fuzzy.”

Clinical Differential Diagnosis

Heart disease – cardiomyopathy, bacterial endocarditis, myocarditis. Lung disease – neoplasia, fibrosis, edema, hypersensitivity. Bladder – neoplasia, bacterial cystitis, uroliths.

Sampling

Full thickness surgical biopsies taken from the liver, omentum, and smaller mass near omental mass. Omental and secondary mass revealed moderate, chronic, fibrosing, necrotizing, omental steatitis.

Note concurrent liver bx revealed mild, chronic, multifocal, lymphohistiocytic hepatitis with mild, hydropic vacuolar hepatopathy. (Images not shown)

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Patient Information

Patient Name : Copper H

Gender : Female, Spayed

Species : Canine

Type of Imaging : Ultrasound

Status : Complete

Liz Wuz Here : Yes

Code : 11_00013

History

Incontinence
Levothyroxine therapy
UTI

Exam Finding

Heart Murmur
Tachypnea

Images

Blood Chemistry

Alkaline Phosphatase (SAP), High
Hypothyroidism

Urinalysi

Bacteria Present
Calcium Oxalate Crystals Present
Culture negative
WBCs Present