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When Enough is Enough: Ultrasound-Guided Ascent Into Heaven

Ashley C. Barfield April 4, 2007. When Enough is Enough: Ultrasound-Guided Ascent Into Heaven. Several months of weight loss Vomiting 2-3 times a day for 3 days Decreased energy Small amount of diarrhea for 3 days Recent diet change. Winston Counterman 14-year-old miniature Schnauzer.

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When Enough is Enough: Ultrasound-Guided Ascent Into Heaven

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  1. Ashley C. Barfield April 4, 2007 When Enough is Enough: Ultrasound-Guided Ascent Into Heaven

  2. Several months of weight loss Vomiting 2-3 times a day for 3 days Decreased energy Small amount of diarrhea for 3 days Recent diet change Winston Counterman14-year-old miniature Schnauzer

  3. CBC Mild leukocytosis Moderate anemia Severe thrombocytopenia Chemistry BUN = 50 ALKP = 272 AMYL = 1287 TGL = 214 ALB = 1.9 Labwork Abnormalities

  4. Radiographic Abnormality RDVM noted decreased serosal detail consistent with abdominal effusion

  5. Large heterogenous splenic mass and multiple heterogenous nodules The Good Stuff

  6. Large heterogenous hepatic mass and multiple nodules Liver…It’s So Good

  7. Bilaterally decreased corticomedullary definition, multiple heterogenous nodules, multiple cysts, one hypoechoic nodule Kidney: Not just for breakfast anymore

  8. Grossly enlarged and heterogenous right medial iliac lymph node And the Badness

  9. Large amount of echogenic peritoneal fluid, consistent with hemorrhage (accompanied by a normal pancreas); aspiration yielded fluid hemorrhagic in appearance The Sauce

  10. Interpretation “These findings are consistent with metastatic neoplasia.” -- Tony Pease DVM MS

  11. How to Save Winston? • Aspirates of liver, spleen, kidney, lymph node • Thoracic radiographs (additional met check) • Transfusion and surgical resection of bleeding mass • Surgical resection/debulking of other masses • Chemotherapy and radiation therapy based on histopath results • Serial imaging to monitor progress during therapy Winston’s owner elected humane euthanasia to prevent further suffering.

  12. 6-month history of chronic weight loss Watery diarrhea of unknown duration No change in appetite or energy level No PU/PD or vomiting FELV/FIV negative indoor cat Pumpkin Rogers12 year-old spayed DSH

  13. CBC Mild normochromic, normocytic anemia Thrombocytopenia Hypoproteinemia Stress leukogram (elevated SEGS & monos, decreased lymphs) Chemistry Hypoalbuminemia Hypoglobulinemia Mildly elevated ALT Mildly elevated ALKP Labwork Abnormalities

  14. Urinalysis 1+ proteinuria 4+ bilirubinuria T4 = 0.53 (1-4) Labwork Abnormalities

  15. Mildly thickened small and large intestinal walls Again, the Good Stuff

  16. Bowel walls also fluid-filled Top differentials: Neoplasia Inflammatory bowel disease

  17. Hyperechoic kidneys with decreased corticomedullary distinction

  18. Hypoechoic liver

  19. Peritoneal fluid & possible pancreatic edema

  20. IBD or Lymphoma? • Full-thickness or endoscopic intestinal biopsies • Mesenteric lymph node aspirates • Liver and kidney aspirates

  21. What if it’s the big K? Met check/staging • Thoracic rads • Peripheral lymph node aspirates • Serial imaging during therapy • Prognosis • 6 months to >2 years • severity of disease (histopathologic grade and tumor phenotype) • response to chemotherapy

  22. Pumpkin’s Situation • Loss of 50% of body mass in 6 months • Potential involvement of liver and kidneys • Owners elected no further diagnostics • Owners elected pred and ice cream therapy Pumpkin died at home the next day

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