History
| 8 year old male neutered German Shepherd Presented with a 1 week history of inappetence, lethargy and tachypnea. The patient recently moved from Arizona to Florida, one month prior to presentation. The following blood work findings were identified at the pDVM four days before presentation: CBC- thrombocytopenia Blood smear- evidence of clumping Chemistry- elevated ALT Urinalysis- 2+ leukocytosis but otherwise unremarkable. Leptospirosis testing- negative. The patient was prophylactically started on antibiotics (amoxicillin and doxycycline). After returning home, the patient had an episode of collapse and was taken to another emergency clinic where thoracic radiographs and an echocardiogram were performed. The patient was diagnosed with atrial fibrillation and was started on diltiazem. The echocardiogram suggested an increased left atrial size, but no underlying cause for the arrhythmia was identified. |
CT of the abdomen, transverse plane, pre-contrast
Transverse CT of the abdomen after contrast administration (venous phase)
CT of the abdomen, dorsal plane, arterial phase
CT of the abdomen, sagittal plane, arterial phase
CT of the abdomen, dorsal plane, venous phase
CT of the abdomen, dorsal plane, delayed
Imaging findings:
– Moderate generalized hepatomegaly.
– Lobulated kidneys with extensive multifocal hypoattenuating regions
– Large well-defined and small ill-defined splenic nodule.
– Multifocal splenic mineralization as with dystrophic mineralization from prior thrombosis.
– Small left adrenal gland nodule without evidence of intravasation.
– Moderate amount of non-obstructive mineralized gallbladder sediment.
Liver: In association with the reported clinical findings, an acute hepatitis is considered a primary differential for the hepatomegaly. Alternatively, a vacuolar hepatopathy or less likely infiltrative neoplasia (e.g. lymphoma or mast cell tumor) are also considered.
Spleen: Differentials for the larger splenic nodule include neoplasia, such as hemangiosarcoma or histiocytic sarcoma, or benign etiologies (e.g. extramedullary hematopoiesis or nodular hyperplasia). The smaller nodule may represent a myelolipoma, similar neoplastic process or other benign etiologies.
Kidneys: Renal changes are most compatible with severe chronic infarction; however, neoplasia (e.g. lymphoma) is also a consideration.
Left adrenal gland: The nodule may represent a benign process (e.g. hyperplasia or adenoma) or early metastatic neoplasia, such as adenocarcinoma or pheochromocytoma.
The patient was euthanized and underwent necropsy. Necropsy findings:
Liver: The liver is moderately swollen with rounded edges. Additionally, it is diffusely mottled tan to brown and has a prominent reticular pattern. The liver is markedly friable.
Spleen: A solitary, well-demarcated, smooth-surfaced, soft, dark red nodule is present on the anterior aspect of the tail of the spleen.
Kidneys: Both kidneys have numerous multifocal, variably sized, round to slightly irregular, white foci that are slightly raised and extend into the renal parenchyma. On cut sections, both kidneys also contain 1-3 small, wedge-shaped, dark red lesions that extend from the cortex through the medulla and renal pelvis (infarcts).
Left adrenal gland: Within the caudal pole, there is a firm, tan to yellow, raised nodule.
Histopathology: Lymphosarcoma, kidneys and liver. Spleen: extramedullary hematopoiesis.
No histology is available for the left adrenal gland nodule (presumed nodular hyperplasia).