Today we have an 11-year-old male neutered Siamese cat with a history of vomiting. What are your differentials?
11 year old Siamese
Teaching and learning about veterinary diagnostic imaging.
Teaching and learning about veterinary diagnostic imaging.
Today we have an 11-year-old male neutered Siamese cat with a history of vomiting. What are your differentials?
Is the stomach wall on the first lateral radiograph shown thickened, especially evident ventrally? Also looks thickened cranially on the DV image? Is there a soft tissue mass associated with the transverse/descending colon gas opacities on the DV view also? The descending colon appears quite dilated with gas/faeces – could constipation or megacolon be present here?
Am bit stumped on this one and to be honest if these were my x-rays in practice and I wasn’t fairly convinced that there was going to be something wrong with them as they were part of a radiology interpretation case, I would have told the owner that there was nothing to see! I would have recommended a haematology, biochemistry (incl. T4, fPLI), urinalysis and possibly a faecal analysis. If further investigations weren’t possible due to cost constraints, I would consider chronic pancreatitis, IBD and gastric neoplasia (esp. lymphoma) amongst my most likely differentials and probably start by giving a chicken only diet, some B-vitamins and ranitidine syrup as symptomatic treatment. I would be cautious about starting on preds in case was lymphoma and wished treatment with chemotherapy (but would probably opt for preds+chlorambucil if this was the case rather than CHOP-based protocol anyway). I would take a more thorough history to try to limit my differential list down from all potential causes of vomiting, e.g. is the vomiting associated with eating (likely primary gastrointestinal) or is haematemesis present? If that was all normal I might try a barium-study or abdominal ultrasonography.
The descending colon is deviated to the midline and there is a mass on the left mid-abdomen, closer to the left kidney on VD. There are some gas dilated intestinal loops, possibly from mechanical ileus. I would consider intussusseption on my top differentials. I´m sorry if there is something wrong about my english!
The colon is somewhat redundant making it look like there might be a mass on the v/d, though the laterals look normal. I’d be careful diagnosing wall thickening on radiographs without contrast. The fluid distribution in the bowel can make deceivingly thick looking walls. I don’t give you bloodwork on these cases so it’s a bit tough, though that would be the next step 🙂 Hint: take a close look at the kidneys.
The kidney size is increased (normal size should be less than 2.5 times the length of L2 ; here, kidneys measure about 3 times the length of L2). Shape is however regular. Differentials of bilateral nephromegaly with regular shape include neoplasia (lymphoma), amyloidosis, hydronephrosis, glomerulonephritis and large renal cyst. A biochemistry and abdominal ultrasound should be performed to precise the diagnosis. (… Sorry for my frenchy english…)
Hi Dra. Zwingenberg. I am new to this site and found it very interesting.
In that case, I agree with fellow cometary above. kidneys appear with increasing size (reference values). This animal did ultrasound? I see multiple cysts and lymphoma appearing with high frequency in Persian.
Fernando Cavaletti
Ṣo Paulo РBrazil