Case Study 8: Tiger, Feline Right Adrenal Carcinoma and Lung Met. **

History: This 14-year-old MN DSH presented for weight loss, increased respiratory effort, and progressive anorexia. The physical exam confirmed minor tachypnea, poor body score, grade 2/6 systolic heart murmur, but was otherwise normal. The CBC presented mild leukocytosis with a left shift. The blood chemistry was normal except for a moderate elevation in amylase and mild elevation in CPK. Urinalysis: PH 6.5, USG 1.026, glucose 2+, blood 3+, epithelia rare.

Clinical Differential Diagnosis: Pancreatitis, neoplasia, cardiac disease, feline asthma, Heartworm disease, thromboembolic disease causing the respiratory embarassment.

Sonographic Interpretation: See images.

Image 1

It is not possible to distinguish whether the echogenic structure invading the vena cava is clot, mass invasion, or both.

Sonographic Differential Diagnosis: Adrenal adenocarcinoma or pheochromocytoma with caval invasion, less likely benign hyperplasia with caval clot. Lung lesion: lung metastasis, thromboembolism, infammatory consolidation, infectious disease.

Sampling: Post mortem examination revealed right adrenal undifferentiated adenocarcinoma with medullary obliteration and confirmed pulmonary metastasis after histopathological review of the lesions presented here.

Comments: The lung lesion noted was only one of many diffuse lesions found on post mortem. The radiographs presented at the time of the sonogram were from 1 week prior and were interpreted as normal with no visible lung densities noted. This was one of 3 lesions that were close enough to the thoracic wall to obtain an echogenic window without lung air artifact. The patient was euthanized due to clinical decline 7 days post diagnosis.

Referring Practitioner: Stacey Lipitz-Kilcullen DVM, Little Silver Animal Hospital, Little Silver, NJ, USA.