Can you tell the difference between true fatty liver in a cat (pathological) vs just a fat infiltrated liver in a fat cat? Is there a difference? I recently performed a cancer screen in a hypercalcemic cat who was otherwise clinically doing well but had an elevated ionzied Ca2+ and normal PTH and no other abnormal blood parameters. The cat was fat, BCS 5/5.
Can you tell the difference between true fatty liver in a cat (pathological) vs just a fat infiltrated liver in a fat cat? Is there a difference? I recently performed a cancer screen in a hypercalcemic cat who was otherwise clinically doing well but had an elevated ionzied Ca2+ and normal PTH and no other abnormal blood parameters. The cat was fat, BCS 5/5.
The liver was hyperechoic with decreased portal markings. The liver margins were normal. GB, pancreas, GI normal. I did find a single hyperechoic nodule in the left liver lobe measuring under 1cm diameter and am recommending monitoring this. All else was normal.
In may report, I stated the presence of a hyperechoic liver but wasn’t sure to call this a fatty liver or most likely fat infiltrated liver of a fat cat. Maybe I’m thinking too much? What do you think? Jacquie
Comments
Hi Jaquie!
I really
Hi Jaquie!
I really apologize for the delayed response!
I don´t think that a differentiation between hepatic lipidosis and a fat infiltrated liver in a fat cat is not possible based on ultrasound alone. Both can have a similar appearance. In a report I would stick to what I see; In this case I would simply write down the fact that the liver was hyperechoic and mention some possible differentials, including lymphoma. And I would recommend a FNAB since this can be done without checking the coagulation. In my experience cats with confirmed lipidosis have almost always an increase in liver enzymes (ALT).
Any other thoughts, Remo?
Hi Jaquie!
I really
Hi Jaquie!
I really apologize for the delayed response!
I don´t think that a differentiation between hepatic lipidosis and a fat infiltrated liver in a fat cat is not possible based on ultrasound alone. Both can have a similar appearance. In a report I would stick to what I see; In this case I would simply write down the fact that the liver was hyperechoic and mention some possible differentials, including lymphoma. And I would recommend a FNAB since this can be done without checking the coagulation. In my experience cats with confirmed lipidosis have almost always an increase in liver enzymes (ALT).
Any other thoughts, Remo?
I agree with Peter that it is
I agree with Peter that it is difficult/impossible to differentiate on ultrasound. Lipidotic cats have elevated liver enzyme activity – often very high ALP activity. FNAB is easy to do and fairly non-invasive and can be evaluated in-house. Cytology of lipidosis shows hepatocytes full of fat globlets and rules out other diseases such as lymphoma and possibly cholangio-hepatitis.
I agree with Peter that it is
I agree with Peter that it is difficult/impossible to differentiate on ultrasound. Lipidotic cats have elevated liver enzyme activity – often very high ALP activity. FNAB is easy to do and fairly non-invasive and can be evaluated in-house. Cytology of lipidosis shows hepatocytes full of fat globlets and rules out other diseases such as lymphoma and possibly cholangio-hepatitis.
Hello
I agree with you
Hello
I agree with you recommendations, but I think Jackie’s question is also my own (Jackie correct me if I’m wrong), i think, I’ve discuss this before with the patologist, but can’t remember the outcome of the talk
Peter and Remo, Yes there are more deferentials as you mention and you can do a FNA easily.
But do you use the therm/nomenclature in your report differentials: fatty infiltration of the liver vs. lipidosis? Considering lipidosis the fat vacuoles on liver cells, v.s. fat accumulations on the interstitial hepatic tissue as fatty infiltration.
Related also how do you call the fatty infiltration of the renal feline cortex? Do you consider it physiologic or pathological? I think of it as physiologic in older/fatter/neutered cats and mention it as so in the reports (even tough i still give a list of differentials of kidney disease for
hyperechoic cortex’s here)
Cheers
Hello
I agree with you
Hello
I agree with you recommendations, but I think Jackie’s question is also my own (Jackie correct me if I’m wrong), i think, I’ve discuss this before with the patologist, but can’t remember the outcome of the talk
Peter and Remo, Yes there are more deferentials as you mention and you can do a FNA easily.
But do you use the therm/nomenclature in your report differentials: fatty infiltration of the liver vs. lipidosis? Considering lipidosis the fat vacuoles on liver cells, v.s. fat accumulations on the interstitial hepatic tissue as fatty infiltration.
Related also how do you call the fatty infiltration of the renal feline cortex? Do you consider it physiologic or pathological? I think of it as physiologic in older/fatter/neutered cats and mention it as so in the reports (even tough i still give a list of differentials of kidney disease for
hyperechoic cortex’s here)
Cheers
Fatty liver vs fat cat I
Fatty liver vs fat cat I usually match with clinical signs and clin path. Clinical fatty liver will go with sap as remo says and usually bili and there is usually something else that goes with the lipidosis…panc, obstructive urinary or something else to cause them to stop being a cat and go anorexic. Fat cat liver is usually incidental and I see a more uniform hyperechoic presentation and the infrastructure is well defined but lipidosis usually has a puffy cloud appearance but its like looking at ink blots. BTW I always compare to fal fat on these as normal liver should be isoechoic to falciform fat. if anything clinical i stick wiht 25 gauge and I never like a liver nodule in a cat. Dogs I will give them benefit of the doubt if non clinical but cats I always try to stick a liver nodule as cats don’t do benign nodules as well as dogs do in my experience. Here is a lipidotic cat liver image.
Fatty liver vs fat cat I
Fatty liver vs fat cat I usually match with clinical signs and clin path. Clinical fatty liver will go with sap as remo says and usually bili and there is usually something else that goes with the lipidosis…panc, obstructive urinary or something else to cause them to stop being a cat and go anorexic. Fat cat liver is usually incidental and I see a more uniform hyperechoic presentation and the infrastructure is well defined but lipidosis usually has a puffy cloud appearance but its like looking at ink blots. BTW I always compare to fal fat on these as normal liver should be isoechoic to falciform fat. if anything clinical i stick wiht 25 gauge and I never like a liver nodule in a cat. Dogs I will give them benefit of the doubt if non clinical but cats I always try to stick a liver nodule as cats don’t do benign nodules as well as dogs do in my experience. Here is a lipidotic cat liver image.
Here is a fat cat liver from
Here is a fat cat liver from the normals dvd. this if not clinical and fat I don’t stick. If anything minimally clinical or an sap bili rise then stick for sure. Great thread thx for the input
Here is a fat cat liver from
Here is a fat cat liver from the normals dvd. this if not clinical and fat I don’t stick. If anything minimally clinical or an sap bili rise then stick for sure. Great thread thx for the input
I think you can see form
I think you can see form these 2 images the subtle differences in the puffy cloud loss of detail and curvilinear infrastructure appearance in the lipidotic cat and the smooth curvilinear liver infrastructure in the fat cat liver. The diffs are subtle but i think we can see the difference with improved image quality that was not available in past years…but again an ink blot thing
I think you can see form
I think you can see form these 2 images the subtle differences in the puffy cloud loss of detail and curvilinear infrastructure appearance in the lipidotic cat and the smooth curvilinear liver infrastructure in the fat cat liver. The diffs are subtle but i think we can see the difference with improved image quality that was not available in past years…but again an ink blot thing