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13 year old DSH with anorexia and vomiting

Input appreciated on this case (financial limitations)

      • 13 year old MC DLH cat
      • 2-3 month history of inappetance, vomiting
      • blood work shows increased GGT (mild) but otherwise NSF
      • ultrasound shows (in my opinion) multiple areas where there is loss of normal layering (proximal duodenum, ileum, one segment of duo) but it doesn’t appear to be the muscularis layer as typical with lymphoma
      • the ICC LN are enlarged, irregular and cystic and concern me, but the owner declined FNA, cannot afford. The image shown below is only about 1 of 3 enlarged LN/masses visible in that area.
      • The area of SI shown below (not the pylorus) is close to the abnormal LN
      • The ICCJ is very thickened on the side of the ileum, and it appears to be the muscularis that is thickened (hypoechoic).
My thoughts are that this is most likely neoplasia and that we could probably get an answer with a few FNAs including the affected LN and liver. Your thoughts appreciated. I cannot upload the video as it is too large.

Images follow

Liz

4 responses to “13 year old DSH with anorexia and vomiting”

  1. Liz you may get an answer on

    Liz you may get an answer on fna of the LN and send to CSU in case pcr is necessary for lsa dx as many times these come back “lymphoid” and the cytologist is on the fence. the intestinal detail loss can be complicated ibd (penetrating bacteria), emerging MCT, Dry fip and lsa and need full thickness and intraoperative US best here. no 3 ECVIM 2009 and see June and april 2011 cases of the month.  If they can;t do anything but throw pills at it I have a lot of luck with my wasting triad cocktail: Zithromax 50mg sid x 3 weeks, pred 2.5/5 mg.cat, hypoallergenic diet and b12 injections 2 x weekly. Covers most the treatable in $ cases and seems to work and keep the owners from thinking euthanasia.

  2. Liz you may get an answer onLiz you may get an answer on fna of the LN and send to CSU in case pcr is necessary for lsa dx as many times these come back “lymphoid” and the cytologist is on the fence. the intestinal detail loss can be complicated ibd (penetrating bacteria), emerging MCT, Dry fip and lsa and need full thickness and intraoperative US best here.  If they can;t do anything but throw pills at it I have a lot of luck with my wasting triad cocktail: Zithromax 50mg sid x 3 weeks, pred 2.5/5 mg.cat, hypoallergenic diet and b12 injections 2 x weekly. Covers most the treatable in $ cases and seems to work and keep the owners from thinking euthanasia.

  3. I’m trying to post a post
    I’m trying to post a post mortem picture but I seem unable to do so?
    Well, the cat was euthed yesterday, and necropsy was allowed. The intestine was variably thick with areas that were extremely thin/dilated. I now know why I was struggling with the ICCJ (I kept thinking I saw two of them) — there was a stricture about 3 inches orad from the ICCJ causing severe dilation of the ileum. Local lymph nodes large and very dark. FNA prelim looks like mast cell, but I’m no pathologist. Sent biopsy samples to the lab for interp professional interest and I’ll post when I get results.

  4. I’m trying to post a post
    I’m trying to post a post mortem picture but I seem unable to do so?
    Well, the cat was euthed yesterday, and necropsy was allowed. The intestine was variably thick with areas that were extremely thin/dilated. I now know why I was struggling with the ICCJ (I kept thinking I saw two of them) — there was a stricture about 3 inches orad from the ICCJ causing severe dilation of the ileum. Local lymph nodes large and very dark. FNA prelim looks like mast cell, but I’m no pathologist. Sent biopsy samples to the lab for interp professional interest and I’ll post when I get results.

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