These images are from a 15 (about) year old cat belonging to a shelter. He has intermittent diarrhea and vomiting. He has early renal disease with BUN/creat 49/2.1 and isosthenuria. Am I seeing an IBD type of pattern here? The remainder of the scan seemed normal.
These images are from a 15 (about) year old cat belonging to a shelter. He has intermittent diarrhea and vomiting. He has early renal disease with BUN/creat 49/2.1 and isosthenuria. Am I seeing an IBD type of pattern here? The remainder of the scan seemed normal.
Comments
Usually at that age with
Usually at that age with enlarged reactive jejunal/colic lymph nodes and adjacent fat I would put intestinal lymphoma as my top differential. It seems there is subtle loss of wall layering at the ileo-colic junction, but it is not clear.
IBD could be another differential, but less likely.
Lets hope the gods of veterinary ultrasound will have pity on us mortals and illuminate us with their clairvoyance
Thank you very much. Hope for
Thank you very much. Hope for further opinions as well…
Lol… I would say more IBD
Lol… I would say more IBD as the layering seems largely ok but resolution is a bit tough and i can see how it seems to have layer loss. Emerging lsa maybe but also usually lsa brings more node action with it and the nodes here are small and length to width is holding ok. Moreover usually lsa is a “bursting at the seams” scenario like pushing on a grape and the peel starts to rupture…. reactive mesentery occurs. Just search “intestinal lymphoma” in the sonopath search here.
https://sonopath.com/members/case-studies/cases/suspected-multicentric-lymphoma-involving-small-intestine-kidney-and-blad
Look for the fuzzy fat on the serosal surfaces as well as irregular thickening of the wall as opposed to uniform thickening wihtout reactive mesentery… this can happen with IBD but when layering loss and rounded nodes and reactive mesentery occurs thenm Im putting lsa first and fip mct and complicated IBD in that order. So I would say IBD first for this image set in this thread and progressively worse in my ddx.
Thank you for your
Thank you for your enlightment
EL, in this case would you put him thorough a biopsy? It is a 15yo cat with kidney issues.. . Maybe appropiate diet, maropitant, low dose prednisolone and a little bit of hope could be the more sensible thing to do? What do you think!?
I think every old cat in the
I think every old cat in the end needs a little minimal effective does of quality of life prednisolone and maybe supportive nutrition to keep weight on:)
Pam, I think that it would
Pam, I think that it would really help if you used the Crossbeam feature on your machine . I would also set the speckle noise reduction to between 3 or 4. It will help with your images.
I am not convinced of IBD but as the others have commented, the images aren’t really ideal to evaluate it.
when I look for signs of IBD one thing thjat I search for is a regional section relatively hyperechoic mucosa that is often very limiuted. Attached is a very high resolution image of a segment of jejunum. Here I measure ratios of the sub mucosa to that of the muscularis layering. They change with IBD and lymphoma. Since one disease is a reflection of the other the hypertrophy of the muscularis layering starts with IBD.
In IBD and especially in an older cat such as yours I would expect that it would have had time to accent these typical changes. It may be the imaging but I am not seeing it clearly here.
What you could do is measure the PH of the vomit. If it is ~4 it is gastric therefore less likely to be only IBD. If it is 6-7 then the possibility increases.
On a last side note for the same reasons as mentioned above, I do not see reactive nodes. Sorry to be so confusing.
Thank you very much for the
Thank you very much for the comments!
If you look closely at the
If you look closely at the image of the distal ileum entering the ascending colon or the jejunum you will note that the mucosa is hyperechoic to the thickened muscularis layering.
The final image is a case of small cell lymphoma whereby the invasive cells are localised in the villous zone of the mucosa. Look closely at the regional involvement when compared to the wall in the far field. This is why I think that you will see the possible lesions better if you use the linear probe.