VUS Case of the Month - October/November 2018

Submitted by: Vionna Kwan, DVM and Michaël Lora-Michiels, DVM, MS, DACVR, BluePearl Veterinary Partners Midtown NY

Signalment & History:

  • 10 yo MN Bernese Mountain Dog (34 kg) presented for inappetence
  • Historically, has had multiple surgeries and endoscopies for gastric FBs
  • He was previously treated with chemotherapy in June 2018 for suspected multicentric neoplasia (r/o histiocytic sarcoma) based on clinical symptoms and AUS findings at the time
  • Chemistry showed mild ALT (442)/ALP (724) elevation and mild BUN (76) elevation
  • CBC showed stress leukogram and severe basophilia (3564)
  • An abdominal ultrasound was pursued to further evaluate symptoms

 

 

 

Answer:
An abdominal ultrasound was performed:

  • Liver was diffusely hyperechoic.
  • Spleen had a 2.4 cm inhomogeneous, vascularized, mostly hypoechoic mass associated with the tail, deforming the capsule.
  • Small intestines had a subjectively thickened wall with a prominent muscularis layer.
  • Gastric fundus contained cystic-like, partially fluid-filled rounded ~3 cm thin-walled structures with inhomogeneous echogenic material.
  • Kidneys had irregular hyperechoic cortices, decreased cortical medullary distinction, dilated renal pelvis, and multiple cystic lesions (largest one measuring approximately 1.2 cm).
  • Remainder of abdomen was normal.

A repeat ultrasound 24h later showed persistent partial cystic-like and inhomogeneous structures in the stomach and a segment of small intestines with thickened walls and altered layering with strong shadowing.

An abdominal exploratory laparotomy was performed to remove the gastric foreign body, the spleen, and to biopsy any abdominal tissue.

  • The gastric “foreign body” turned out to be multiple unchewed, undigested, intact hard-boiled eggs, without shells. The owner confirmed that these were fed to the patient.
  • Biopsies of the liver showed severe cell swelling and vacuolar change.
  • Biopsies of the spleen were consistent with lymphoid hyperplasia and extramedullary hematopoiesis.
  • Biopsies of the GI tract showed moderate lymphoplasmacytic and eosinophilic enteritis with dilated lacteals, consistent inflammatory bowel disease and lymphangiectasia.