Hi, I have this cat: reccurrent episodes of vomiting which responds to symptomatic treatment. Tendency to eating plastics according to owner. CBC and biochem are usually normal. US for further diagnostics.
Questions:
Hi, I have this cat: reccurrent episodes of vomiting which responds to symptomatic treatment. Tendency to eating plastics according to owner. CBC and biochem are usually normal. US for further diagnostics.
Questions:
I can see a hypoechoic (relatively)-poorly defined area in pylorus, which I consider abnormal. It does not seem to be due to oblicque angles since it is round and obvious in multiple different views. I am attaching longitudinal view and transverse views. There does not seem to have regional Lns enlargement. No other major findings. only reactive medial iliac Lns with normal S/L axis ratio. What differentials does this include…being so focal I thought inflammatory is unusual???
Also, initially I thought stomach was completely empty, then I see an accumulation of “something” with hyperechoic surface and distal echoshadowing which I assumed was gas but now I’m not so sure (just after revising the clips). Any inputs in video number 3? I am always very worried to diagnose a FB that is not…
I suggested rescanning for monitoring. I was thinking 4-6 weeks but now I wonder whther I should re-scan again on empty stomach for that potential FB like…tomorrow. So that to see whether that is still there or not…
Thanks for helping.
Silvana.
Comments
The pylorus has a focal
The pylorus has a focal hypoechoic area in the wall and you lose the submucosal layer (arrow). I would keep an eye out for lymphoma or similar here an dmay be causing a delayed outflow given the stricturing appearance. If it grows a bit you can usg fna it. In the last video there is a mix of fluid chyme on the left, but in the fundus a 2 cm something is there that can be plastic, grass blades or ribbon or even a broken up hairball (arrow). Could scope… anytime a patient is vomiting often despite med tx the scope is warranted especially if the problem is mucosal or luminal.
I just wanted you to see that
I just wanted you to see that I posted a similar case last October.
You can access the case here: https://sonopath.com/forum/pylorus-mass
The point I wanted to make was that I aspirated this mass 3 times and could not get it to exfoliate. When I posted the cat I could see my needle marks and bruising going straight into the mass. Histopath confirmed LSA. I am not saying you should not try to aspirate, but don’t be surprised if it comes out negative.
Thank you Eric and Randy. I
Thank you Eric and Randy. I will discuss Fna and endoscopic approach for this one.
try the “corkscrew technique”
try the “corkscrew technique” it will allow you to carve out cells on fna in small and tough spaces. Straight jab or woodpecker technique likely won’t exfoliate well here.