ULTRASONOGRAPHIC APPEARANCE OF SPLENIC DISEASE IN 101 CATS

JENNIFER
A. HANSON,
MARCPAPAGEORGES,
ELISABETH MENARD,
MICHELE
GIRARD, HEBERT
PIERRE

The sonographic findings in 101 cats with splenic abnormalities are presented. Diagnosis was made by
ultrasound-guided fine needle aspirate or fine-needle biopsy (n = 91), ultrasound-guidedcore biopsy (n
= l), surgical core biopsy (n = l),or necropsy (n = 10). Two cats had more than one diagnostic procedure
(fine needle aspirate and necropsy or core biopsy and necropsy). The splenic abnormalities included
lymphosarcoma (n = 30), mast cell tumor (n = 27), extramedullary hematopoiesis and/or lymphoid
hyperplasia (n = 27), epithelial tumors (n = 6), mesenchymal tumors (n = 4), malignant histiocytosis (n
= 2), myeloproliferative disease (n = 2), pyogranulomatous inflammation (n = 2), erythroleukemia (n =
1), eosinophilic syndrome (n = l),hematoma (n = l),and granulomatous splenitis (n = 1). Three cats had
more than one splenic abnormality (mast cell tumor and metastatic carcinoma, pyogranulomatous
inflammation and lymphoid hyperplasia, histiocytic lymphosarcoma, and lymphoid hyperplasia). Pa-
thognomonic changes were not seen for any of the diseases. Veterinary Radiology & Ultrasound, Vol. 42,
No. 5, 2001, p p 441-445.

Key words: feline, spleen, splenic, ultrasound.

Introduction Material and Methods

The ultrasound logs of Tufts University School of Vet-
I N ONE SURVEY of 152 feline necropsy specimens 5.9% of
the cats had splenic lesions,' while in another survey of
necropsy and surgical specimens the prevalence of splenic
erinary Medicine (January 1986 to April 1995) and Veteri-
nary Diagnostic Imaging & Cytopathology (January 1993 to
September 2000) were searched for cats with necropsy, bi-
lesions was only 0.3%.2 In the two studies neoplastic con-
opsy, or aspirate diagnoses of splenic disease within one
ditions accounted for 55% and 37% of the splenic abnor-
month of an abnormal ultrasonographic examination. The
malities, therefore non-invasive diagnosis of splenic disease
spleen was evaluated for size, echogenicity relative to the
is of considerable importance in cats. Definitive diagnosis
liver, regularity of the contour, homogeneity of the paren-
permits differentiation of disease in which splenectomy is
chyma, and presence of nodules or masses. Extrasplenic
indicated, such as mast cell tumor3 and mesenchymal neo-
abnormalities were also recorded. One hundred and one cats
plasia, from diseases in which medical therapy is indicated.
were identified. The ultrasound scans were performed with
There are few reports in the literature regarding the ul-
various machines using 7.0 or 7.5 MHz mechanical or
trasonographic appearance of feline splenic disease. Myelo-
phased array transducers.* Static ultrasound images of the
proliferative disease in one cat was described as a 3 4 cm
abnormalities and videotape of the examinations were avail-
hypoechoic mass in the ~ p l e e n .Splenic
~ lymphosarcoma
able for review for 65 of the cases. In one case, there was a
was described as a diffuse or multifocal hypoechoic finding,
discrepancy between the ultrasound-guided core biopsy re-
as irregularity of the splenic border, and as a single cavitated
sult and the necropsy result. The necropsy result was re-
mass in a series of ten dogs and five cats, but it was not
corded as the final diagnosis.
stated what changes were seen in what species.' The spleen
of a cat with systemic mast cell tumor has been described as Results
homogeneously hypoechoic.6 The purpose of this study is to
describe the ultrasonographic findings in 101 cats with The study population consisted of 69 Domestic Shorthair
splenic disease and to compare these findings to those re- cats, 17 Domestic Longhair cats, 6 Siamese or mixed
ported for canine splenic disease. Siamese, 2 Himalayans, 1 Persian, 1 Burmese, 3 Maine
Coon Cat, and 1 Ragdoll. The breed of 3 cats was not
recorded. Fifty-one were females or neutered females, 46
From Veterinary Diagnostic Imaging & Cytopathology, 16900 SE X2"d were males or neutered males, and the gender of 4 cats was
Drive, Clackamas, OR 97015.
Address correspondence and reprint requests to Dr. Hanson, Veterinary
Diagnoytic Imaging & Cytopathology, 16900 SE X2"d Drive, Clackamas, "Ultramark 8, Advanced Technology Laboratories, Bothell, WA; Aloka
OR 97015. 500, Coronietrics Medical Systems, Wallingford, CT; Toshiba SSH- 140A,
Received February 16, 2001; accepted for publication April 30, 2001. Toshiba Corporation, Tochigi-Ken, Japan

44 1
442 HANSON
ET
not recorded. Age ranged from 2 years to 18 years, with a
mean of 1 1 years. Presenting signs were non-specific. The
most common clinical signs were anorexia or decreased
appetite ( n = 35), weight loss ( n = 34), weaknessllethargyl
depression (12 = 23), and vomiting ( n = 22). Physical
examination findings included palpable abdominal mass or
splenomegaly ( n = 4.3, palpable abdominal effusion ( n =
12), mucous membrane pallor ( n = 12), fever ( n = 9), and
icterus ( n = 9). Anemia, usually severe, ( n = 31) and
elevated total bilirubin or liver enzymes ( n = 3 1) were the
most common laboratory abnormalities. Leucopenia ( n =
9) and leucocytosis ( n = 9) were also observed.
Twenty-five of the 30 cats with lymphosarcoma had
splenomegaly (83%). In 8 of those cats, splenomegaly was
the only splenic change. In 16 of the cats with lymphosar-
coma and an enlarged spleen (53%), the spleen was also
diffusely hypoechoic, mottled in texture, and/or contained
many small hypoechoic foci (Fig. 1). One cat had an en-
larged spleen and a single, 2.4-cm hypoechoic mass. Three
cats with splenic lymphosarcoma, but without splenomeg-
aly, had single, hypoechoic splenic masses. In one cat with
lymphosarcoma, hypoechogenicity was the only splenic ab-
normality. One cat had a normal size spleen with many 1-2
cm hypoechoic nodules throughout the parenchyma.
Fourteen of the cats with lymphosarcoma had abdominal
effusion in addition to the splenic changes. Thirteen had at
least one enlarged abdominal or retroperitoneal lymph node,
and 19 (63%) had hepatic abnormalities (hepatomegaly, a
diffusely hyperechoic or hypoechoic liver, or hepatic nod-
ules). All but one of these cats also had lymphosarcoma in
the liver. One cat with a focal splenic mass diagnosed as
lymphosarcoma also had intestinal lymphosarcoma, and 2
other cats with splenic lymphosarcoma had isolated ab-
dominal masses that were diagnosed as lymphosarcoma by
fine needle biopsy.
Both cats with myeloproliferative disease had a large and
FIG. I . Spleen and left kidney (L Kid) of a cat with splenic lymphosa-
rcoma. Note the two hypoechoic nodules that deform the splenic contour.
The larger one is approximately 1 cm in greatest dimension (calipers).
AI 200 1
diffusely hypoechoic spleen. The spleen affected by eryth-
roleukemia was large, normal in echogenicity, and had an
irregular border (Fig. 2). The cat with eosinophilic syn-
drome had splenomegaly as the only ultrasonographic ab-
normality. None of these cats had hepatic changes or lymph-
adenopathy. One cat had abdominal effusion.
The splenic changes in the 27 cats with mast cell tumor
were similar to those seen in cats with lymphoproliferative
and myeloproliferative diseases. Twenty-five of the 27 cats
(93%) had splenomegaly of varying severity, and spleno-
megaly was the only splenic abnormality in 6 of those cats.
One cat had a small, hypoechoic spleen that was infiltrated
with mast cells. In the single cat with a normal size spleen,
the spleen was nodular and had an irregular contour. Nine of
the enlarged spleens (33%) were also irregular in contour
and 17 of the 27 (63%) were either diffusely hypoechoic or
nodular/mottled. An unusual finding was that in 2 cats with
large, nodular spleens, the nodules were hyperechoic rather
than hypoechoic. In one cat, the spleen was large and dif-
fusely hyperechoic. In 7 cats, splenic mast cell tumor ap-
peared ultrasonographically as a single mass or nodule.
Eight of the cats with mast cell tumor in the spleen (30%)
also had hepatic changes as described above. Six of those
cats, and 2 other cats with normal-appearing livers, had
mast cell tumor in the liver as well. Mast cell tumor was
diagnosed in the mesenteric lymph nodes in 4 cats, in a
small intestinal mass in 1 cat, and in an isolated mass near
the right kidney in 1 cat. Abdominal effusion was present in
9 of the 27 cats with splenic mast cell tumor (33%).
Eleven of 27 cats (41%) with extramedullary hemato-
poiesis and/or lymphoid hyperplasia had splenomegaly with
normal echogenicity. In 8 of the 1 I , the splenic margin was
irregular. Seven cats with extramedullary hematopoiesis
and/or lymphoid hyperplasia had focal hypoechoic nodules
or masses in the spleen ranging in size from 0.7 cm to 3 cm.
One cat had a discrete, 0.5-cm hyperechoic nodule, while 2
cats had very small, non-shadowing hyperechoic foci
FIG.2. Spleen of a cat with erythroleukemia. The margin of the spleen
is markedly irregular. The spleen is surrounded by anechoic fluid.
VOL. 42, No. 5 ULTRASOUND
OF FELINE
SPLENIC
DISEASE 443

throughout the spleen. The spleen was hypoechoic or

mottled in seven cats. Ten cats had various liver changes on
ultrasonography (hepatomegaly, hyperechogenicity, dis-
tended hepatic veins, mottled liver parenchyma, cavitated
hepatic mass). Nine of those cats had liver biopsies. The
hepatic changes were diagnosed as lymphocytic-plasma-
cytic cholangiohepatitis ( n = 6), mixed suppurative and
lymphocytic-plasmacytic cholangiohepatitis ( n = 3), hepa-
tocellular adenoma ( n = I ) , and hepatic lipidosis ( n = I )
(2 cats had more than 1 hepatic diagnosis). Three of the 27
cats ( 1 1%) had abdominal effusion; 1 cat had an exudate
associated with feline infectious peritonitis, 1 cat had a tran-
sudate secondary to carcinomatosis, and 1 cat had chyloab-
domen of undetermined cause.
The 10 focal splenic neoplasms were easy to see ultra-
FIG. 4. Undifferentiated sarcoma in the spleen of a cat (between cali-
sonographically. In 70% of these cats, the spleen was not pers). Note the more irregular shape and the focal anechoic and hypoechoic
enlarged. The 2 hemangiosarcomas contained anechoic foci, changes with this tumor, compared to Figure 3.
similar to findings in canine splenic hemangi~sarcoma.~
Both cats with splenic hemangiosarcoma had abdominal feline infectious periotonitis. Both of the cats had abdomi-
effusion. The other 2 sarcomas did not look similar. One nal effusion and a large spleen of normal echogenicity. In
was poorly demarcated from the rest of the spleen and con- one of those cats, the spleen was irregular in contour. One
tained multiple small ill-defined hypoechoic areas (Fig. 3). cat had granulomatous splenitis, characterized by a large
That cat had no effusion. The other sarcoma was irregular in and mottled spleen. That cat also had effusion.
contour and of mixed echogenicity (Fig. 4), and was ac-
companied by a large volume of abdominal effusion. The 5 Discussion
metastatic carcinomas were well defined, single, anechoic
to hypoechoic nodules, and 1-2 cm in diameter. The ma- Much of the literature regarding the imaging features of
lignant epithelial neoplasm was an inhomogeneous 3 cm splenic disease refers specifically to dogs. This retrospective
mass associated with an enlarged and irregularly shaped study was undertaken to see whether previously published
spleen. That cat had effusion. findings are also applicable to cats with splenic disease.
The cat with the splenic hematoma, diagnosed by nec- Feline splenic disease is more likely to be neoplastic, com-
ropsy 5 days following the ultrasound exam, did not have a pared to canine splenic disease.* In this study 73% of the
focal splenic abnormality. The spleen in that cat was large, splenic changes were neoplastic. Early, non-invasive diag-
mottled in texture, and irregular along its margins. There nosis is therefore of great importance, particularly as the
was hemorrhagic abdominal effusion (Fig. 5). clinical signs of splenic disease are vague. Presenting signs
Two cats had pyogranulomatous splenitis associated with may also be due to concomitant disease, with splenic ab-

FIG. 3. Undifferentiated sarcoma in the spleen of a cat (between cali- FIG. 5. Splenic hematoma and hemorrhagic effusion (asterisks) in a cat.
pers). The mass di5torts the splenic capsule but is difficult to distinguish The splenic contour is irregular (arrows) and the splenic parenchyma is
from the rest of the splenic parenchyma. diffusely mottled.
444
normalities discovered as incidental findings. Palpable
splenomegaly is often easily appreciated in cats, but is a
non-specific finding that benefits from further evaluation
with ultrasonography. Unlike the canine spleen, the feline
spleen is nonsinusal, with slightly less blood storage capac-
ity.8 This anatomic difference suggests that severe spleno-
megaly would less likely be physiologic in the cat. Spleno-
megaly may be a response to another disease, for example,
extramedullary hematopoiesis in the presence of anemia or
passive congestion secondary to liver disease. The spleen
may also be the more ultrasonographically sensitive harbin-
ger of multisystemic disease such as lymphosarcoma.'~9
Ultrasonographic assessment of the spleen can be subjec-
tive, because the shape, size, and position of the normal
spleen are variable. Therefore the experience of the sonog-
rapher may play a role in assessing for abnormalities. In the
cat the spleen is usually superficially located along the left
body wall, while in the dog it may course transversely
across the abdomen. While there are no landmarks for judg-
ing splenic size, it is rare for the feline spleen to fold upon
itself unless it is enlarged (Fig. 6). Like the canine spleen,
the feline spleen has a finer echotexture than that of the
liver, and is more echogenic. The splenic capsule is very
echogenic, and should be smooth and regular. The decision
to biopsy the spleen is almost always based on an abnormal
ultrasound appearance. Unlike liver and kidney disease, for
which lab-work may provide the indication to biopsy de-
spite a normal sonographic appearance, there are no specific
hematologic abnormalities to confirm splenic disease.
In dogs with splenic lymphosarcoma, the spleen may
contain hypoechoic to anechoic nodules with a diffusely
hypoechoic or normal background echogenicity.' The
spleen may also be diffusely hypoechoic or contain a single
mass.' All of these findings were noted in the cats of this
report as well. The most common description of splenic
lymphosarcoma in these cats was a large, hypoechoic or
FIG.6. Large, folded feline spleen with otherwise unremarkable archi-
tecture. The fine needle aspirate diagnosis was lymphosarcoma.
HANSON
ET AL. 2001
nodular spleen with a smooth margin (53%). The combina-
tion of splenic and hepatic abnormalities (63%) or abdomi-
nal effusion and a splenic abnormality (47%) was also com-
mon. The variability of the sonographic appearance of lym-
phosarcoma is likely due to whether the infiltrative cells
remain centered in the white pulp, which would create a
multinodular appearance, or whether there is diffuse infil-
tration of the spleen.'" Compared to dogs, cats have little
periarterial lymphatic tissue, with the lymphatic tissue con-
fined to nodules of white pulp.' Therefore, splenic lympho-
sarcoma might be expected to appear nodular more often in
the cat, but that was not found in the cats reported here.
Perhaps the smaller lymphatic nodules that are present in
cats2 appear uniform even when infiltrated with neoplastic
cells.
No characteristics allowing differentiation of cats with
lymphosarcoma from cats with mast cell tumor were ob-
served, although a higher percentage of cats with lympho-
sarcoma had abdominal effusion (47% for lyrnphosarcoma
and 33% for mast cell tumor) and almost 3 times as many
cats with lymphosarcoma had mesenteric or retroperitoneal
lymphadenopathy (43% vs. 15%). The spleen of cats with
splenic mast cell tumor was more likely to have an irregular
contour than cats with lymphosarcoma (37% and 3% re-
spectively). The only hyperechoic splenic changes were in
cats with mast cell tumor, suggesting that small hyperechoic
nodules or diffuse hyperechogenicity may be uncommon,
but specific findings in splenic mast cell tumor in cats.
Little has been written about the ultrasonographic appear-
ance of extramedullary hematopoiesis and lymphoid hyper-
plasia in veterinary medicine. In a recent abstract, lymphoid
hyperplasia was described in 3 1 dogs9 In that series, all but
one of the nodules were hypoechoic or of complex echoge-
nicity. The spleen may be normal or diffusely hypoechoic in
''
people with extramedullary hematopoiesis. Again, lym-
phoid hyperplasia might be expected to present as a multi-
focal change, centered on the white pulp, with extramedul-
lary hematopoiesis changes appearing more diffuse, but this
was not the situation in the cats reported here. Relative to
the cats with lymphoproliferative or myeloproliferative dis-
ease, it was less common for the extramedullary hemato-
poiesis/lymphoid hyperplasia group to have abdominal
lymph node enlargement (30% vs. 11%) or abdominal ef-
fusion (40% vs. 7% if the cat with FIP is excluded). How-
ever, whether these findings can be applied to other patients
might depend on the underlying causes of the extramedul-
lary hematopoiesis and lymphoid hyperplasia.
The nonspecificity of both focal and diffuse ultrasono-
graphic abnormalities of the feline spleen mirrors that seen
'*
in dogs. Even distinguishing between normal, benign dis-
ease and neoplasia with ultrasonography is not always pos-
sible. For example, in this series a higher percentage of cats
with non-neoplastic splenic disease had splenic masses,
compared to the group with splenic neoplasia. Therefore,
VOL. 42, No. 5 OF FELINE
ULTRASOUND SPLENIC
DISEASE
definitive diagnosis requires cytologic or histologic evalu-
ation. The reliability of fine needle sampling for diagnosis
of hemangiosarcoina has been q ~ e s t i o n e d , 'but
~ most au-
thors advocate aspiration for splenic abn0rma1ities.I~This
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