?thoracic changes and ALP elevation

Re: ?thoracic changes and ALP elevation

Christopher Saul — Fri, 24 Jan 2014 21:04:13 GMT

Hi Marie

I can't really add a huge amount to what others have said already but one little thought :-

If it does take a turn for the worse and you find yourself with the lovely chap under sedation again, it might be worth running a serum protein electrophoresis. I know the degree of hyperproteinaemia isn't huge - and may be explained by haemoconcentration - but it could be on the way up so could be relevant. Could be useful to characterise this; If you get a monoclonal gammopathy could point you in the direction of a multiple myeloma; I wonder if the bone lesion is relevant in this respect.....

Just a thought, feel free to disregard!!

Chris

Re: ?thoracic changes and ALP elevation

Marie Kubiak — Thu, 23 Jan 2014 14:52:07 GMT

[quote user="Gerry Polton"]

I think it is simply positional, an artefact. I get referred radiographs quite often with this (though none from a binturong).

You have the coolest job

[/quote]

Good to know, will avoid doing more drastic bits with this then.

The job's not so bad :)

Re: ?thoracic changes and ALP elevation

Linda Filshie — Thu, 23 Jan 2014 14:44:18 GMT

Good to know he's doing well!

I've never seen a trachea kink like that artefactually but now I will include it in my list of differentials, thanks to Gerry.

Re: ?thoracic changes and ALP elevation

Hanna Bennett — Wed, 22 Jan 2014 20:40:14 GMT

suddenly our grumpy cat is in perspective...

Re: ?thoracic changes and ALP elevation

Gerry Polton — Wed, 22 Jan 2014 18:20:22 GMT

[quote user="Marie Kubiak"]Thanks - what do you think the slight deviation of the trachea on the lateral view?[/quote]

I think it is simply positional, an artefact. I get referred radiographs quite often with this (though none from a binturong).

You have the coolest job

Re: ?thoracic changes and ALP elevation

Marie Kubiak — Wed, 22 Jan 2014 14:14:32 GMT

[quote user="Gerry Polton"]

Hi Marie

I don't see evidence of mediastinal disease. Given the economic constraints I would support a conservative course of reassessing after rehydration and again after a few weeks provided that the clinical signs did not progress adversely. I agree that the appearance of the ilium is abnormal but, like you I think, I am not convinced that this is relevant to his presenting complaint. Had he been on intravenous fluids when you took the radiographs? His bladder is remarkably distended for a patient with blood test results indicating quite a degree of dehydration. Dehydration and hypochloraemia indicates possible vomiting. Is it possible that vomiting has been present but has been missed by his keepers? If so, this could be a relatively uncomplicated case of dietary indiscretion.... or even pancreatitis, despite how much we dislike amylase as a diagnostic test for anything.

Thanks for the photo

Gerry

[/quote]

Thanks - what do you think the slight deviation of the trachea on the lateral view?

He hadn't been on fluids up until sedated at the time of Xrays - neither handling nor maintaining a drip line was an option until he was asleep, even when sick! His bladder wasn't tense on palpation and he urinated a couple of times in the 24hrs post-fluids but nothing in the 4hrs while in prior to fluids. Urine looked quite concentrated by assessing on bedding but it wasn't possible to collect this sample and I didn't think to cysto him while sedated I'm afraid - he decided to stop breathing part way through and a calm rational approach went out the window.

No vomiting observed but in a large enclosure with natural substrate and lots of plants, water features etc and with over-worked keepers it could very easily be missed. Normal faeces was passed in the hospital which made me less convinced of GI origin of WBC changes and faecal culture/parasitology was unexciting but pancreatitis is still one thing I haven't been able to exclude. I was told later on that they have been scatter feeding the otters who share his enclosure and he may have been scavenging left overs so over-feeding or eating less than fresh food is still a definite possibility!

I would ideally like to sedate him and repeat bloods this week and then repeat Xrays of ilium and chest in a couple of months but I suspect if he continues to do well this will be declined on stress/cost grounds. I'm pleased for the moment as a literature review seemed to produce only reports of anorexic binturongs that invariably died of viral/neoplastic causes determined at post-mortem and none of them showed any improvements so we are doing ok thus far!

Marie

Re: ?thoracic changes and ALP elevation

Gerry Polton — Wed, 22 Jan 2014 13:53:02 GMT

Hi Marie

Thanks for the photo

Gerry

Re: ?thoracic changes and ALP elevation

Marie Kubiak — Wed, 22 Jan 2014 10:59:23 GMT

Just a quick update - the binturong is completely back to normal, eating well, active and its normal vile self! Hopefully this is a true response to treatment rather than a temporary upswing following supportive care.

Re: ?thoracic changes and ALP elevation

Marie Kubiak — Thu, 16 Jan 2014 12:29:03 GMT

[quote user="Linda Filshie"]A case of wait and see then. Shame they're not wanting to work up further at this stage, but you never know, it could just have a mediastinal abscess that the convenia will cure!

[/quote]

Fingers crossed!

Re: ?thoracic changes and ALP elevation

Linda Filshie — Thu, 16 Jan 2014 12:28:25 GMT

A case of wait and see then. Shame they're not wanting to work up further at this stage, but you never know, it could just have a mediastinal abscess that the convenia will cure! (Ok, that's wishful thinking a bit - I would expect a marked neutrophila in that case).

Re: ?thoracic changes and ALP elevation

Marie Kubiak — Thu, 16 Jan 2014 12:22:23 GMT

They have decided to see if he improves on just fluids and antibiotics and are reluctant to go for scanning at this stage for cost reasons but may go for it if he doesn't improve. He seems a little brighter this morning and has gone back to his main enclosure but certainly is still quiet and showing no interest yet in food (though is very stressed after hospitalisation). I can't help but feel I'm missing something and have an ominous feeling about this case...

Re: ?thoracic changes and ALP elevation

Marie Kubiak — Wed, 15 Jan 2014 21:11:18 GMT

[quote user="Linda Filshie"]

I wouldn't say common - but would certainly be on my list for an anterior mediastinal mass in a cat or dog- lymphoma would be on there too, of course (always on the list for everything under the weather!)

[/quote]

Thank you. Will put the scan option to them and let you know what happens...

Re: ?thoracic changes and ALP elevation

Linda Filshie — Wed, 15 Jan 2014 20:16:28 GMT

Re: ?thoracic changes and ALP elevation

Marie Kubiak — Wed, 15 Jan 2014 20:12:06 GMT

[quote user="Linda Filshie"]

Not sure what to make of the iliac lump, but there's a definite kink to the trachea at the level of the third rib on the lateral, and I think, with a bit of "eye of faith" that there seems to be increased opacity at this level on the DV. Thymoma? Did you check calcium? AlkP elevates with so many things that I find it not terribly helpful...

Ultrasound guided FNA of the (presumed) thoracic mass possible?

[/quote]

Thanks! A full biochem and haem was run but I only have values scanned as an image and was too lazy to type them all out! Total Ca is within normal limits for a dog - 2.79 (2-3) and Ca ranges are usually fairly consistent across the carnivores so I am hoping this is a suitable reference point.

Ultrasound to aspirate is possible and I can probably persuade them though money always plays a part so I want to be sure I'm targeting my testing well as been very broad and vague so far! Never seen anything other than a rabbit with thymoma - is it common in domestic carnivores?

Marie

Re: ?thoracic changes and ALP elevation

Linda Filshie — Wed, 15 Jan 2014 20:03:16 GMT

You get to see some very interesting creatures, Marie!

Ultrasound guided FNA of the (presumed) thoracic mass possible?