This is a telemed cat I have been following for some time … a chronic triad cat diabetic that now shows intestinal detail loss and clinically and uncharacteristically went hyopoglycemic stimulating the recheck sonogram by Andi Parkinson RDMS of Intrapet Imaging.

This is an example of an email only read that i provide as a service but though would be solid as a forum post because I love the 2 birds with one stone concept … though I have nothing against birds:)

This is what I told my client:

I never like a diabetic cat that all of a sudden decides not to be diabetic any more unless early in the diabetic state as they can go into remission within the first few months with management but when they have been diabetic for some time and then start dropping their glucose or going into DKA when everything has been consistent rgearding diabetic management. This is a red flag that something else is going on and have to hope for pancreatitis or a UTI or bad insulin or something. In this image set there are new areas of intestinal detail loss (arrows) that meet neoplastic criteria and free fluid is also adjacent to those wall thickenings with LN that are enlarged and losing detail as well. The local fluid (when transudate or modified transudate) is usually from “lymphatic strangulation” where hydrostatic pressure from the LN creates local third spacing. If inflammatory fluid is present then intestinal necrotic and perf should be considered. This local fluid + detail loss tissue being the case we need to sample those structures… in this case the LN and the intestine with detail loss. Best is by intra-operative US (http://sonopath.com/resources/interventional-procedures/intraoperative-ultrasound) and resect the lesions at the red lines I show there in these images where the bowel integrity and mural detail is in tact while resecting the regions of detail loss that meet “neoplastic criteria.”

Things that do this: Lymphoma deriving from IBD as they can coexist.. we have proven that ECVIM 2009 (http://sonopath.com/resources/research-publications), other less likely MCT, FIP, complicated IBD with bad bacteria or similar.

The pancreas is a bit irregular and hypoechoic with irregular and dilated pancreatic duct as well typical of chronic triad cat (see image). Some parenchymal detail loss is p[resent there as well so progressive disease, lymphoma, necrosis or nodular hyperplasia does this.

Needs samples… may get an LSA on LN fna but send to CSU for cytology or telecytology with SonoPath and if PCR needed CSU would have the slides or if telecytology you would have the slides still in house ready to send for PCR (CSU) or PARR (NC state) if thats needed to differentiate lymphoid from lymphoma.

But “cutting” to the chase with shopping spree of intraoperative Bx is the best approach to get to the bottom of it with a probe in hand.

If you haven’t employed IOP US for these cases its really cool and major wow factor re diagnostic efficiency and very quick and easy to do once you do it.

Happy New Year everyone!