Case Study

Pancreatic abscess and suppurative pyogranulomatous inflammation in a 4 year old FS DLH cat

A 4-year-old FS DLH presented for weight loss, hair loss, hematochezia, and hair pulling. Physical exam revealed poor body condition with non-inflammatory alopecia. The CBC was normal. Blood chemistry analysis revealed mildly elevated total protein and globulins. Urinalysis showed a pH of 6.5, USG > 1.050 with a cloudy appearance, 5-10/hpf WBC, TNTC RBC, rare casts, and rare bacteria. The fecal was negative for parasites.

A 4-year-old FS DLH presented for weight loss, hair loss, hematochezia, and hair pulling. Physical exam revealed poor body condition with non-inflammatory alopecia. The CBC was normal. Blood chemistry analysis revealed mildly elevated total protein and globulins. Urinalysis showed a pH of 6.5, USG > 1.050 with a cloudy appearance, 5-10/hpf WBC, TNTC RBC, rare casts, and rare bacteria. The fecal was negative for parasites.

DX

Pancreatic abscess. Suppurative pyogranulomatous inflammation.

Sonographic Differential Diagnosis

Pancreatic abscess, rule out possible underlying carcinoma.

Image Interpretation

Image 1 shows pancreatic enlargement with well-circumscribed mixed echogenic change and predominantly hyperechoic irregular echoes throughout the pancreas. Image 2 shows a large 5.5 cm thick-walled cystic structure affecting pancreas. There is echogenic material inside of the cyst suggestive of either highly cellular contents, gas accumulation, or mineralization. Video 1 shows injection of antibiotics into affected area after drainage.

Outcome

The patient recovered slowly during the postoperative period, but was stable at suture removal and follow-up.

Clinical Differential Diagnosis

Urinalysis abnormalities – pyelonephritis, UTI, urolithiasis. Weight loss – pancreatitis, inflammatory bowel disease, maldigestion, neoplasia, infectious disease, and FIP.

UA PH

6.5

UA PH

6.5

Sampling

US-guided drainage of the abscess was performed with a 20g IV catheter. 14cc of frank pus was obtained. This cavity was injected with enrofloxacin (20 mg) post drainage as a palliative measure while stabilizing for surgery. Surgical resection was then performed. After 1 week, evaluation revealed partial return of the abscess and the need for debulking of the pathology. Fluid culture (aerobic/anaerobic): Staphylococcus intermedius, light growth, highly sensitive. Ultrasound-guided FNA (22g) of the pancreatic parenchyma revealed hemorrhage with pyogranulomatous inflammation and debris. A surgical biopsy revealed suppurative pyogranulomatous inflammation. Tissue of origin involved both pancreas and liver. Extension along pancreatic and biliary ducts were suspected.