Dear all, this is the second case of potentially PKD I see in the past 10 days. Just a bit of reassurance on the correct diagnosis and next step forward.
– 5 years 7 months old FN British shorthair cat. presented for sudden onset of loss of apetite and a 1 time green vomitus.
-CBC: mild lymphopenia (1.2, min 1.5). Marginal Ca elevation (12, max 11.8), low Phosphorus (2.8, range 3.4-8.5). NO AZOTEMIA. Normal liver enzymes and TBIL.
Dear all, this is the second case of potentially PKD I see in the past 10 days. Just a bit of reassurance on the correct diagnosis and next step forward.
– 5 years 7 months old FN British shorthair cat. presented for sudden onset of loss of apetite and a 1 time green vomitus.
-CBC: mild lymphopenia (1.2, min 1.5). Marginal Ca elevation (12, max 11.8), low Phosphorus (2.8, range 3.4-8.5). NO AZOTEMIA. Normal liver enzymes and TBIL.
-ULTRASOUND: marked polycystic kidneys. Cysts appear somewhat irregular and cavernous with trabeculas rather than empty. Numerous focci of distrophic mineralization inside and outside cystic lesions (in parenchyma). Both kidneys afected. Size is mildly enlarged (4.5cm kidneys, approx). Liver: 2 cystic structures; one in left lobes parenchyma of approx 2cm diameter (kind of irregular in size), one very round cystic structure beside or originating from CBD. GB appears mildly distended. Patient is very painful in the area. Reactive surrounding mesentery. No free fluid. To me…the cyst is actually not linked to CBD, but i cannot be sure.
-Questions: with the (to me) irregular cystic appearance, high calcium and low phosphorus and lack of Azotemia…can this be neoplasia rather than purely PKD? Are FNA/biopsy needed or contraindicated? What about the cystic lesion in CBD? I think considering the extent of lesions, and being bilateral, prognosis is poor regardless of whether PKD or neoplasia…Im just trying to decide whether we should do anything about the cystic area in CBD.
Thanks for any input.
Comments
The kidneys look like pkd
The kidneys look like pkd with mineralization/stones. FNA never hurts.
the “cyst” in the liver is a dilated cbd as its continuous with the cystic duct and then the gb. Need to follow that to the d-pap and see whats obstructing it whether stone, mass, polyp or mucous plug.
Thanks, EL. I really tried my
Thanks, EL. I really tried my best to follow it…with not much success…as in, I do not see anything obstructing…Now Im all worried I missed something…TBIL was not elevated…at least on the 31st may…today… might be different… I reviewed my clips…I just do not see anything, I actually see a normal CBD distal to the cyst that goes to DPAP…and in teh transition…I just do not see anything…At what point do you decide whether they need surgery…I will ask my colleague to check TBIL tomorrow.
Bilirubin doesnt elevate in
Bilirubin doesnt elevate in all posthepatic disease… it tends to be late phase. In our dog study bili was elevated only 40% of th etime wiht surgical biliary disease.
Cats will be ADR wiht bile duct carcinomas or plugs and bile still squeaks through enough to not elevate serum values.
You can try medical here for a week and recheck the scan and if the dilation is increasing then needs sx but this looks veyr much like biliary carcinoma to me and solid. If its my cat I would explore directly and see what’s up.