RAD – mediastinal lymphadenomegaly, lobar interstitial infiltrate likely round cell neoplasia in a 12 year old FS Flat Coated Retriever dog

Case Study

Case Study

RAD – mediastinal lymphadenomegaly, lobar interstitial infiltrate likely round cell neoplasia in a 12 year old FS Flat Coated Retriever dog

This 12 year old FS Flat Coated Retriever dog presente with vomiting of 3 month duration with a 5 day history of coughing. Weight loss 12 pounds (15% body weight) over 3 months. 

Physical Exam: Thin (BCS 2/5) with poor hair coat. Lungs auscultate WNL, mild to moderate, generalized muscle atrophy (MCS = 3/4). Splenomegaly evident on palpation. 

CBC: Mild neutrophilia (13,500/uL). Hct 41% (attached) 

Chemistry: Low albumin (2.5 g/dl), high globulin (3.9 g/dl), high amylase 1765. T4 1.2 mg/dl  

This 12 year old FS Flat Coated Retriever dog presente with vomiting of 3 month duration with a 5 day history of coughing. Weight loss 12 pounds (15% body weight) over 3 months. 

Physical Exam: Thin (BCS 2/5) with poor hair coat. Lungs auscultate WNL, mild to moderate, generalized muscle atrophy (MCS = 3/4). Splenomegaly evident on palpation. 

CBC: Mild neutrophilia (13,500/uL). Hct 41% (attached) 

Chemistry: Low albumin (2.5 g/dl), high globulin (3.9 g/dl), high amylase 1765. T4 1.2 mg/dl  

Urine Analysis: USG 1.009. Active sediment with rods. 

DX

Severe mediastinal lympadenomegaly • Lobar interstitial infiltrate • Mild megaesophagus • Aerophagia • Hypovolemia with underperfusion of the lung • Gastric and possible esophageal foreign material without signs of mechanical obstruction or peritonitis

Image Interpretation

Rads of the thorax – An isolated ossicle is seen at the infraglenoid process of one glenoid cavity which is an incidental finding. Mild signs of spondylosis and spondylarthrosis are noted at the disc space L1/2. Except for this the included bony structures are within normal limits.
Severe enlargement of the cranial mediastinal and tracheobronchial lymph nodes is noted. There is splitting of the main stem bronchi and steep ventral dip of the carina view owing to the severe enlargement of the tracheobronchial lymph nodes whereas the trachea is lifted cranial to the heart due to the enlargement of the cranial mediastinal lymph nodes.
The esophagus is mildly dilated with gas.
An ovoid caudodorsal mediastinal soft tissue mass is seen cranial to the diaphragmatic crura.
The heart is pushed ventrally.
The caudal vena cava and pulmonary vasculature are thin.
The cranial portion of the left cranial lung lobe reveals a generalized interstitial pattern with maintained lung volume.
The stomach is moderately distended with gas. An ovoid soft tissue opaque structure is seen within the pyloric antrum.
The heart is normal for size and shape. The major vessels and pulmonary vasculature are within normal limits. There is no indication of vascular congestion.
Two interstitial soft tissue nodules are seen within the caudoventral lung field.
There is a moderate generalized bronchointerstitial lung pattern with bronchial wall mineralization, mild peribronchial cuffing and multifocal cylindrical bronchiectasis.

Outcome

The radiographic findings are compatible with round cell neoplasia of the mediastinal lymph nodes. In a Flat coated Retriever the main differential diagnosis is histiocytic sarcoma next to lymphoma. A granulomatous disease is a possible differential but is very very low for potential.
The lobar infiltrate within the left cranial lung lobe is likely to be a neoplastic round cell infiltrate. In case sampling is strived, ultrasound guided fine needle aspiration of the left cranial lobe would be an option as the lymph nodes are unlikely to be accessible with ultrasound.
The megaesophagus is likely to be paraneoplastic or a consequence of the possible foreign body lodging at the cardia.
Consider ultrasound – if not yet done so – to further define the potential obstructive character of the gastric foreign material.
The aerophagia may be due to the foreign body, stress, pain or dyspnea or a combination of these.

Patient Information

Patient Name : Luna Mimic/AndoverAH
Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes

Clinical Signs

  • Coughing
  • Vomiting
  • Weight loss

History

  • Vomiting

Exam Finding

  • Muscle Wasting
  • Splenomegaly
  • Underweight

Images

bildschirmfoto_2016-02-05_um_16bildschirmfoto_2016-02-05_um_16

Blood Chemistry

  • Albumin, Low
  • Amylase, High
  • Globulin, High

CBC

  • Neutrophils, High

Clinical Signs

  • Coughing
  • Vomiting
  • Weight loss

Urinalysi

  • Bacteria Present
  • Specific Gravity Low
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