Hemangioma in a 10-year old MN DSH Cat: Our Case Of the Month November 2020
Out of the box thinking, dedication, and the right imaging tools solve this puzzle. Thank you to SonoPath’s own Shari Reffi, CVT, SDEP® certified clinical sonographer for navigating through this rather interesting case with her diagnostic images set. Great job by Dr. Summers and her caring team at Blairstown Animal Hospital for managing this sweet cat’s case. US interpretation by Eric Lindquist, DMV, DABVP, Cert. IVUSS and CT interpretation done by Nele Eley, DVM Dr. med. Vet. DipECVDI.
The patient presented for ADR and hiding which was worsening over time. Blood chemistry, CBC, and urinalysis were both unremarkable. The caudal lumbar area of the patient was uncomfortable upon palpation. Radiographs revealed fused tail vertebrae, enlarged heart, and a mass effect in the chest. A double cavity ultrasound was performed and findings confirmed fused kidneys (which had previously been diagnosed) and a pericardial diaphragmatic hernia was noted. Falciform fat was in the pericardial space. The heart did not appear to be dysfunctional owing to this congenital defect. Due to splenic enlargement FNA of the spleen was recommended.
A few weeks later the patient’s clinical signs worsened again. Despite treatment with pain medication, cortisone and antibiotics the patient presented again with dull mentation and not wanting to walk. Upon examination no ataxia or nystagmus was noted but the patient was squinting; there was concern for CNS disease. A CT study was performed at Blairstown Animal Hospital.
Ultrasound: Stable pericardial diaphragmatic hernia, no cardiac dysfunction, congenital renal fusion with mild to moderate degenerative changes, and enlarged spleen.
CT: Extra-axial intercranial neoplasia with severe mass effect onto the ventricular system, cerebral hemispheres, diencephalon, and cerebellum. Foraminal herniation of the cerebellum. Right otitis externa.
Tru-cut surgical biopsies of the brain mass were sent out for pathology review.
The CT findings are compatible with mineralizing meningioma.
The CT study revealed an ovoid irregular shaped extra-axial mass with multifocal mineralization and broad base to the cerebral falx as well as the left parietal bone within the cranial fossa. Left parietal bone hyperostosis is noted. The mass measures approximately 2.0 cm in length and 1.5 cm in height and width each. There is moderate nonuniform contrast enhancement noted throughout the mass. A severe mass effect is seen onto the underlying cerebral hemispheres with severe rightward shift of the cerebral falx. Dural tears are seen along the cerebral falx and left parietal meninges. Both lateral ventricles and the third ventricle are compressed. There is a mass effect onto the diencephalon and cranial aspect of the cerebellum. Caudal foraminal herniation of the cerebellum is seen. Meningioma is supected; meningiomas in cats are typically benign and this one is in a favorable position for surgical removal. The patient was referred out to Garden State Veterinary Specialists where he underwent brain surgery for mass removal; the mass was a benign hemangioma. “Sue” continues to do well maintained on Phenobarbitol and prednisone. His owners are very happy that he is feeling better and mostly back to his old self for now.