Case 12

Presentation:
A 20 yr old neutered male Siamese cat was presented to the AcaseAweek clinic for dyspnea, anorexia, and lethargy. The cat was brought in by people who were watching it while the owners have been away. Vaccination and heartworm prevention status’s are both unknown.


Physical exam:
Weight: 4.5kg
T: 101.2 F
P: 220
R:60
Mouth: severe odontoclastic resorptive lesions and gingivitis
Auscultation: Severe gallop rhythm with grade III systolic murmur with PMI greatest over the LAV valve, respiratory sounds: crackles.
Abdominal palpation: very distended with a fluid wave. No masses were palpated.
Musculoskeletal: Generalized Weakness
General appearance: depressed, dyspneic, weak


CBC and chemistry panel were unremarkable except a mildly elevated BUN and creatinine.

ELISA snap test was positive for heartworm.


Abdominocentesis cytology revealed an obstructive transudate that was mildly cellular, containing mostly round, mesothelial type cells with some neutrophils and few lymphocytes.


Once the cat was stabilized, thoracic and abdominal radiographs were taken and are shown below:

What are the radiographic findings?
What is your diagnosis?
Give differentials for your diagnosis.
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Solution to this case

Solution for case 11

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Radiographic findings:

Skull radiographs showed massive loss of turbinate bones. Loss of alveolar bone on the maxillary side, showing clear tooth roots.

Tentative diagnosis: Tumor (Nasal adenocarcinoma)

Further tests: Nasal biopsy histopathology/cytology, rhinoscopy, bacterial cultures, fungal cultures, nasal swab/lavage, thoracic radiographs.

Differentials:

• Bacterial sinusitis
• Aspergillosis
• Trauma
• Tooth root abscess
• Foreign body
• Coagulopathy

Nasal tumors are rare but found primarily in long-nose breeds. Adenocarcinoma is most common nasal tumors in dogs. The average age for the onset of canine nasal tumors is seven years. The clinical signs typically associated with nasal tumors are sneezing, nasal discharge, epistaxis, exophthalmia, facial swelling, nasolacrimal duct obstruction and, sometimes, neurological disturbances. Deformation of the facial bone, hard palate, or maxillary dental arcade may be visible. These signs are non-specific since they mimic bacterial or mycotic rhinitis, sinusitis, dental diseases, nasal trauma or foreign bodies lodged in the upper respiratory tract. Definitive diagnosis of nasal tumors is achieved by cytology or histopathology. However, the final diagnosis is generally reached at a time when the tumor is already in an advanced stage, and has invaded adjacent nasal structures or more distant organs, such as the brain. The prognosis is generally poor as most nasal tumors are malignant. Radiotherapy and chemotherapy can prolong survival rates and improve the quality of life of dogs. Without treatment, the survival following diagnosis of nasal tumors is usually only a few months.

Aspergillosis, in dogs, is typically localized to the nasal cavity or paranasal sinuses and is usually caused by infection with A fumigatus. Nasal aspergillosis is seen mainly in dolichocephalic breeds. It begins in the posterior region of the ventral maxilloturbinate with signs of lethargy, nasal pain, ulceration of the nares, sneezing, unilateral or bilateral sanguinopurulent nasal discharge, frontal sinus osteomyelitis, and epistaxis. Gross lesions vary considerably with site of infection, but a layer of gray-black necrotic material and fungal growth may cover the mucosa of the nasal and paranasal sinuses. The mucosa and the underlying bone may be necrotic with loss of bone definition on radiographs.

Treatment: The patient was given Cefazolin 500mg (5ml) three times a day. A triple antibiotic ointment was also used when discharge was cleaned off. Tissue biopsy confirmed the adenocarcinoma. As it was a rescued animal, owned opted for euthanasia. If not euthanized we can go for surgery, radiation therapy and chemotherapy, but prognosis is poor.