A 5-year-old MN DSH with history of untreated diabetes mellitus, was presented on emergency for collapse. Physical examination findings were weight loss, pale pink mucous membranes, normal heart and lungs sounds, 5% dehydrated, and a palpable cranial abdominal mass. Abnormalities on CBC and blood chemistry were leukocytosis, neutrophilia, anemia, marked hyperglycemia (>686 mg/dl), elevated ALT activity and BUN, and hyperbilirubinemia. FELV/FIV test was negative. The patient was treated with I.V. fluids, Ampicillin, Metronidazole, and Lantus insulin.
A 5-year-old MN DSH with history of untreated diabetes mellitus, was presented on emergency for collapse. Physical examination findings were weight loss, pale pink mucous membranes, normal heart and lungs sounds, 5% dehydrated, and a palpable cranial abdominal mass. Abnormalities on CBC and blood chemistry were leukocytosis, neutrophilia, anemia, marked hyperglycemia (>686 mg/dl), elevated ALT activity and BUN, and hyperbilirubinemia. FELV/FIV test was negative. The patient was treated with I.V. fluids, Ampicillin, Metronidazole, and Lantus insulin. Blood glucose 12 hours later was 383 mg/dl.
Case Study
Pancreatic mass; possible neutrophilic inflammation in a 5 year old MN DSH cat
DX
Sonographic Differential Diagnosis
Probable hepatic lipidosis with suppurative hepatitis. Granulomatous and mineralizing mass in the area of the left pancreatic base. Rule out pancreatic carcinoma vs. chronic inflammation and dystrophic mineralization.
Image Interpretation
The hepatic parenchyma was uniformly hyperechoic. However, hepatomegaly was seen without disruption of architecture. No masses were noted. Diffuse hyperechoic parenchyma is noted when comparing to falciform fat. A 2.5 cm, mixed hypoechoic granuloma or mass mineralizing at the left pancreatic base was present positioned cranial to the left kidney in the video. This actually resembles a kidney in itself but the mass was contiguous with recognizable pancreatic structures such as the pancreatic duct and capsule and the left kidney was identifiable.
Outcome
The patient was lost to follow up.
Clinical Differential Diagnosis
Diabetes mellitus. Liver clinical signs- diabetic hepatopathy, lipidosis, cholangiohepatitis complex, neoplasia, infectious, toxic. Mass – liver/spleen/pancreas/GI tract/lymph node neoplasia, granuloma, abscess. Hydronephrosis.
Sampling
FNA of the pancreatic mass revealed possible neutrophilic inflammation and the liver sample revealed hepatocellular vacuolation, suggestive of hepatic lipidosis.
Video
Patient Information
Clinical Signs
- Collapse
History
- Diabetes, uncontrolled
Exam Finding
- Dehydration
- Pale Mucous Membranes
- Palpable mass
- Weight loss
Images
Blood Chemistry
- ALT (SGPT), High
- BUN high
- Glucose, High
- Total Bilirubin, High
CBC
- Neutrophils, High
- RBC, Low
- WBC, High
Clinical Signs
- Collapse