Owen is a 12 year old cat that was presented initially 5 days ago with a history of anorexia. No vomiting, diarrhea.
PE unremarkable except temp 40.5 celcius
cbc normal
chem alt 2x normal everything else normal
cat sent home on clavamox
Represented a few days later still not eating. Temp still 40.5
Fpli normal
felv fiv negative
Rads,nothing obvious
Hospitalized, placed on fluid, started on cefazolin, liver dose of metronidazole, gave an antiinflammatory dose of dex and mirtazapine. Owen ate overnight temp initailly went down, but within a day was up again.
Added baytril and did an ultrasound. The liver was diffusely mildly hypoechoic. There were a few tubular/circlar hypoechogenic densities caudal medial to the right kidney. The adjacent fat was hyperechoic. Their is no layering to indicate they are bowel of some sort. I cant follow them, they dont look like any lymph node I have ever seen, so was wondering if I could get some guidance.
Thanks
Sue
Comments
This are distorted and very inflamed LNs with the mesenteric artery in the middle. Put CF on it to see whats a blood vessel and whats a node/lymphatic duct. This very well may be lymphoma or similar and the tubular part may be infiltrated lymph vessels. Needs a 25g needle in the LN thats most accessible and likely spleen and liver to see if its there too. I would culture the fna as well (stick again while pulling back on syringe with sterile saline in it after doing the fna first for cytology wiht woodpecker or corckscrew technique) just in case these are not neoplastic a hot bug may be in there.
Thanks so much. Never thought of dilated lymphatics but that makes sense. I take it CF will not show color, and the node would be a more elliptical vs tubular lymphatic vessels. I don’t do alot of fnas of smaller targets. Do you rotate the probe to make sure you are within the node and not adjacent to it? How can you make sure you are actually in the desired object. Are there fna resources here somewhere. I found a video link but I can’t access it. Thx so much
CF will show the mesenteric artery and vasculature as + but negative on lymph so gives you what to avoid and what to target on fna respectively.
Here these should help. We are currently restructuring the whole sonopath.com to make everthing easier to find and link.
https://sonopath.com/educationevents/ultrasound-resources/ultrasound-guided-procedures/ultrasound-guided-lymph-node-cultu
https://sonopath.com/educationevents/ultrasound-resources/ultrasound-guided-procedures/ultrasound-guided-sampling-procedu