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14-year-old cat with history of gradual weight loss with relatively fair appetite. Blood test shows normal renal function with elevated amylase. There is irregular increase of medulla on the ventral aspect of the kidney. Can it be renal infiltration? lymphoma?. I was able to see a nodule in the left pancreatic region but I was not able to connect it to the pancreas really. I will attach the video here for that also. Can you please check if it is a pancreatic nodule?
Comments
Sorry, attaching two more files for suspected pancreatic nodule
The panc nodule is at the caudal most aspect of the long left panc limb in the cat and superimposes the spleen. Minima architecture and capsule expansion merit a 25g needle. hyperplasia likely but carcinoma or roundcell possible.
The kidney is old chronic kidney with mineralization and in one clip the cranial pole has an infarct but i dont see neoplastic criteria as all structures are in tact with chronic changes and no subcapsular halo.
Im attaching a more typical renal lsa pattern with cranial capsular hypoechoic parenchymal expansion and subcapsular halo with regional enhanced fat/inflammation. When we have the arhcive back up after the sw upgrade is completely finalized search renal lymphoma and otns of cases will come up so you can see the pattern
Thank you Eric. I was basing it on the unusual lymphoma presentation in cats. I am attaching the image from the image library of sonopath. Don’t they look similar? and it does confuse me sometime as such medullary changes can be seen in normal cats also and it can be lymphoma also. How to differentiate sonographically? and when to develop a suspicion when there is only irregular medullary exapansion?
ah very attentive yes well nephritis and early lsa (your archive image here) can look similar so its important that 25g cortical fna is used otherwise we are doing histopathological ultrasound which is dangerous and often incorrect. The sonographic appearance gives us a gut feeling of probabilities but we need a needle to confirm and the good thing about renal lsa is its quite definitive on fna with a monopopulation of lymphoma or lymphoid cells.
also on the archive image this is a bit atypical because this is a cortical cyst kidney with some chronic changes with lsa coming after on top of whatever kidney changes were there before lsa comes to town so not typical and exemplifies the reason to fna. I dont think I would use this archive image as typical lsa in our heads but a reason to fna when the structure starts to lose cm detail or be enlarged in parenchymal fashion.