Page 346 - Feline diagnostic imaging

354 22 Gastrointestinal Disease

(c)

(a) (b)

(d) (e)

Figure 22.7 (a) Right lateral projection of the abdomen of a 4-year-old domestic shorthair with lymphoma affecting the gastric wall.
The thickened gastric wall is outlined by an irregular gas bubble (arrow). Gas bubbles in a normal fluid-filled stomach appear smooth
and circular. A barium series was performed by the referring veterinarian. (b) Left lateral projection of the cranial abdomen of
6.5-year-old cat with decreased appetite, vomiting, and regurgitation one hour after eating. The stomach wall (arrowheads) is
thickened. Ultrasound-guided aspiration of the gastric wall revealed small cell lymphoma. PCR for antigen receptor rearrangements
showed B cell lymphoma. (c) Ventrodorsal projection of the cat in (b) showing the thickened wall. (d) Lateral projection of the thorax
of a domestic longhair with chronic renal disease. The abnormal gas bubble in the stomach at the caudal aspect of the image
suggests a thickened gastric wall. Large cell gastrointestinal lymphoma was confirmed. (e) Ventrodorsal projection of the thorax of
the cat in (d). The abnormal gas bubble is apparent at the edge of the image.

mass is sufficiently large. Masses in the area of the pylorus 22.3.4 Pyloric Abnormalities
can cause delayed gastric emptying. On ultrasonography Pyloric outflow obstruction can be caused by gastric for-
(Figure 22.8), there may be thickening of the gastric wall or eign bodies or neoplasia at the pylorus, as mentioned
altered echogenicity. Although most masses are hypo- above. Other causes include pyloric stenosis, pylorospasm,
echoic, some are hyperechoic. There is often destruction inflammation, hypertrophy, and scar tissue. On survey
of normal wall layers, especially when neoplasia is radiography, the stomach is typically distended with fluid.
advanced. Abdominal lymph nodes may also be enlarged. An opacity might be seen at the pylorus with a foreign body
Differentials include mycotic infection, granulomatous or neoplasm. In some cases, air might outline a foreign
disease, parafungal infection, or necrosis. Aspiration of the body, neoplasm, or other lesion. A persistent asymmetric
intestinal wall and lymph nodes can help to ascertain the filling defect might be seen with pyloric neoplasia or hyper-
cause of disease. plasia. An upper GI series can be helpful in confirming