- 13 year old cat who presented flat, dyspnoeic with crying on abdominal palpation, O suspected poisoning.
- I only saw this cat sedated.
- There were numerous lung nodules. Both kidneys appeared enlarged and hyperechoic, both adrenal glands were also enlarged.
- Can pneumonia present with lung nodules? Do you think the mildly enlarged kidneys and adrenal glands are relevant?
- I wanted to aspirate the lung nodules declined.
- Bloods later showed mild hyperglobuinaemia, leukopaenia, neutropaenia with toxicity on smear.
- 13 year old cat who presented flat, dyspnoeic with crying on abdominal palpation, O suspected poisoning.
- I only saw this cat sedated.
- There were numerous lung nodules. Both kidneys appeared enlarged and hyperechoic, both adrenal glands were also enlarged.
- Can pneumonia present with lung nodules? Do you think the mildly enlarged kidneys and adrenal glands are relevant?
- I wanted to aspirate the lung nodules declined.
- Bloods later showed mild hyperglobuinaemia, leukopaenia, neutropaenia with toxicity on smear.
- Trying to learn from this case as I was told he later died and brought up foul looking fluid from mouth.
Comments
Pneumonia may have a fairly
Pneumonia may have a fairly homogenous, echogenic to hypoechoic appearance, sometimes with an irregular surface, but usually has a multiple comet tail artifacts or lung rockets associated with air entrapment within the lung tissue. Edema secondary to CHF can look similar. Sometimes it can look similar to liver along with lung consolidation.
These nodules look solid to hypoechoic with asymmetrical distortion of the pleural surface. Pulmonary origin of the nodules can be determined if they are moving with breathing. Primary vs metastatic neoplasia or granulomas are possible.
The kidneys are enlarged. Primary rule outs may include lymphoma and FIP. The adrenals are also mildly enlarged with asymmetrical contour. I usually consider stress induced hyperplasia, endocrine disease, hyperaldosteronism when I see adrenomegaly. Acromegaly can also cause renomegaly and adrenomegaly as well. I think infiltrative adrenal disease may be possible.
With the hyperglobulinemia, I’d put neoplasia like lymphoma and FIP at the top of the list in this cat. But, yes, sampling would have been ideal but the prognosis was likely poor looking at those lungs.
Thank you DrMac for
Thank you DrMac for explaining the lung nodules and breaking it down.
Lymphoma would usually be
Lymphoma would usually be very high on my list as well but having said that the lesions are not anechoic enough to be more certain.This will vary with the stage of the disease yet this seems advanced enough to highlight the classical appearance of lymphoma. You will often see lymphoma in the thorax first appear on the margins of the lungs. Attached is an image of this. Look how anechoic it is. Did you have radiographs of the thorax to view. Looks more like primary lung neoplasia with free fluid around some of the nodules (necrosis?). Unfortunately you will never know for sure. I wish that they had let you do the FNA. I am curious as well.
I was not dealing with the
I was not dealing with the client directly and they were waiting for bloods to come back first before spending more but the primary care vet did take xrays. I will get them to post if I can. Thanks.