Senior cat, weight loss, chronic V/D, dermatitis R axillary area.
Normal chem, mild anemia, leukocytosis with neutrophilia/eosinophilia/basophilia.
Treated for the same issues 2 months ago with Depo, got better for a few weeks.
U/S: thickened intestines, large jejunal/colic LN (1cm wide), scant ascites, hyperechoic large liver, dilated intrahepatic bile ducts, GB large, dilated CBD (4mm), thickened wall of the dudeonal papilla, diffusely swollen pancreas (1cm thick).
FNA pancreas/LN declined.
Senior cat, weight loss, chronic V/D, dermatitis R axillary area.
Normal chem, mild anemia, leukocytosis with neutrophilia/eosinophilia/basophilia.
Treated for the same issues 2 months ago with Depo, got better for a few weeks.
U/S: thickened intestines, large jejunal/colic LN (1cm wide), scant ascites, hyperechoic large liver, dilated intrahepatic bile ducts, GB large, dilated CBD (4mm), thickened wall of the dudeonal papilla, diffusely swollen pancreas (1cm thick).
FNA pancreas/LN declined.
Open diagnosis: triaditis, can’t rule out GI lymphoma, diffuse pancreatic neoplasia, hypereosinophilic syndrome, FIP.
Questions:
1) intrahepatic bile ducts and CBD are dilated, w/o icterus and with normal Bili/liver enzymes, is that due to chronic pancreatitis?
2) the duodenal papilla has a thickened wall: chronic inflammation? mass? stenosis?
Thank you!
Comments
Old cats get old ducts…
Old cats get old ducts… cbd, cd and panc ducts all dilate… up to 4 mm is normal and sometimes more in my experince in complete old cat normalcy but maybe triad induced chronic changes as well but not clinical here if LEs are fine. As long as sap is normal, which is highly sensitive parameter in cats owing to short half life, then its just old ducts will be ducts:) Nice cbd and pd imaging here.
The depo may be suppressing lymphoproliferative disease and the sonographic presentation. Also consider neoplasia elsewhere or malassimilation of nutrients or even competitive feeding scenarios at home… this gets forgotten often in wt loss scenarios.
Hi Eric,
Thanks for your
Hi Eric,
Thanks for your input! This is a new (demo) machine, and she “images” so pretty, I see things I am not used to seeing that well, and I think it’s abnormal. First world problem…
Julie
You are welcome julie.
You are welcome julie. Following the cbd in cats is a reat start btu work through larger animals with the same approach now up to a larger rottie… when demoing a machine all cats should scan super pretty they are the easiest to scan well. Ensure the machine you demo scans cat hearts really pretty with the probe that does CW and not just the microconvex. Also ensure the machine scans big dog abdomens really pretty too. Try to scan the cbd in a 100# rottweiler. Thats where you need to be image wise as they get biliary disease too. Thats where the rubber hits the road on us machines. Be prepared that the sales rep may grimace at such qestions or requests because they really don’t want you to go there because they may not be able to win that discussion.
Here are my artcles i wrote on this subject a few years ago they should provide insight so you can caveat emptor your purchase that you will be married to the next 5 years.
https://sonopath.com/node/20521
Thank you so much! I read all
Thank you so much! I read all the info you have on the app too about buying a new machine. I will be in touch with your team soon to discuss more. I will work on following the CBD in large dogs! Thanks for the challenge