In collaboration with Dr. Adrien-Maxence Hespel from the University of Tennessee, we present the following radiology quiz. The goal of this case is to practice identifying radiographic findings and formulating a radiographic diagnosis based on a brief patient description. The final section provides additional information about the treatment.
12 year old cat. Abdominal mass on palpation.
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The patient is over-conditioned. The left kidney is severely enlarged and rounded with lobular margins (approximately 7.0 x 5.0 x 6.6cm; LxWxH). There is wispy fluid opaque streaking in the retroperitoneal space. The right kidney has mildly undulating margins. The small intestines contain a moderate volume of gas and are normal and and uniform in diameter. The stomach and colon are normal. The liver, spleen, and urinary bladder remain normal. There is mild spondylosis deformans at L7-S1. The inguinal lymph nodes are conspicuous.
Mass-like enlargement of the left kidney with associated retroperitoneal effusion/steatitis is most concerning for a neoplastic process (primary consideration is lymphoma, given the history). Mildly undulating right renal margins may represent degenerative change, or early neoplastic infiltration.
The appearance of the small intestines may be a physiologic variant or may indicate nonspecific enteritis.
Conspicuity of the inguinal lymph nodes may represent normal patient variation or metastatic neoplasia.
The patient underwent abdominal ultrasound where tissue sampling of the left kidney were performed.
The severe left renomegaly and ill-defined nodule associated with the cranial pole of the right kidney in combination with the associated subcapsular thickening of both kidneys is most concerning for underlying malignancy (such as lymphoma) with associated perinephric steatitis. The associated perinephric effusion is most concerning for a malignant/lymphomatous effusion; however, inflammatory processes are also considered
Those were consistent with lymphoma.
Notes
This patient was initially seen by Dr Debow
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