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Comparative Gastroenterology

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BACKGROUND
A 7-year old male castrated Persian is referred to your clinic with a history of sporadic anorexia, lethargy for 3 days, depression and segregation from his owner. Increased respiratory effort had also been noted prior to presentation. There is no history of vomiting or diarrhea. The cat is an indoor-outdoor cat with a current vaccine status. At presentation, the cat is underweight (8.4 lbs; 3.7kg; BCS 4/9), and flea dirt is noted associated with the integument. On physical examination, the cat is dehydrated (4 – 6%), has a rectal temperature of 103.2°F, a heart rate of 192 beats/min and a respiratory rate of 54 breaths/min. Wheezing and increased respiratory effort are noted. On abdominal palpation, the abdomen is tense, and the cat vocalizes. The kidneys are asymmetric. Biochemical analysis showed a slightly low BUN, total protein, AlkP and ALT and a very mild increase in T Bili. CBC, urinalysis and serologic tests for dirofilaria/FIP/FeLV/FIV are within normal limits or negative, respectively. Thoracic radiographs do not show any abnormalities besides a mild generalized bronchial pattern. Abdominal radiographs (Image A) are obtained and an abdominal ultrasound is performed (Images B & C).
Authors: Dr. Silke Hecht
Dr. Frank Andrews
Dr. Claudia Kirk
Dr. George Henry

  • What’s your diagnosis?

  • What other diagnostic tests would be helpful in determining the diagnosis?

  • What treatment(s) would be appropriate?

 
DIAGNOSIS

Right lateral and VD radiographs of the abdomen show loss of visceral detail within the peritoneal cavity.  There is a mottled appearance to the midabdomen, with a mixture of soft tissue and fat opacities in this region. In the caudoventral abdomen there is an indistinct mass lesion. The possibility of a distended urinary bladder silhouetting with fluid or other soft tissue within the abdomen was considered. Radiographic diagnosis: Mottled soft tissue/fluid opacity in the abdomen compatible with fluid and suspect soft tissue mass or masses of undetermined etiology. Differential diagnoses included neoplastic effusion, peritonitis, hemorrhage or mesenteric neoplasia. 

The ultrasonographic examination revealed a moderate volume of echogenic abdominal effusion.  Mild pyelectasia was noted associated with both kidneys, and the renal cortices were hyperechoic. In close proximity to the duodenum and most likely associated with the right limb of the pancreas, a 1.5 cm hypoechoic mass lesion was noted. Associated with the mesenteric fat, especially in the right cranial abdomen, there were numerous hypoechoic nodules and foci, most of which were rather ill-defined. Mesenteric lymphadenopathy was evident. The liver, the spleen, the urinary bladder and both adrenal glands were within normal limits.

A presumptive diagnosis of pancreatic neoplasia such as pancreatic adenocarcinoma with carcinomatosis and neoplastic effusion was made. The possibility of diffuse infiltrative neoplasia (lymphoma, mesothelioma) was also taken into consideration. The possibility of granulomatous disease (FIP) was considered unlikely. The renal changes were considered to be of unlikely clinical significance at this point.

Abdominocentesis and fine needle aspiration of a mesenteric nodule were performed under ultrasound guidance. Fine needle aspiration of the described mass lesion in close proximity to the duodenum was attempted but was unsuccessful. Cytology of peritoneal fluid and mesentery were consistent with carcinomatosis or mesothelioma.

Treatment options included intracavitary and intravenous chemotherapy as well as supportive treatment. Due to the poor prognosis the owner elected euthanasia. Necropsy was not permitted.
 

COMMENTS TO IMAGES:

Image A
There is lack of serosal margin detail, and there is a mottled, inhomogenous appearance to the peritoneal space. An ill-defined mass effect is seen in the caudal abdomen.

Image B
Image B: Transverse image of the right cranial abdomen. There is a 1.5cm hypoechoic mass (arrows) lesion immediately adjacent to the descending duodenum (arrowheads).

Image C
Spread throughout the mesentery, there are numerous hypoechoic nodules (arrows).