Pancreatolithiasis in a cat: Multimodal imaging approach

A 12-year-old, neutered, male cat was presented for a 4-day history of acute vomiting, lethargy and abdominal pain. The cat was diagnosed with suspected triaditis 8 months earlier. Abdominal ultrasonography (US) showed a mildly enlarged and hypoechoic pancreas surrounded by a small amount of free fluid and markedly hyperechoic fat. The pancreatic duct was mildly dilated, and a hyperechoic shadowing structure within the lumen was visualised (Figure 1A). The gall bladder, cystic duct and common bile duct were dilated. Computed tomography (CT) findings confirmed the presence of a 5 mm linear mineralised structure within the lumen of the pancreatic duct (Figure 1B). No other lithiasis were detected. An exploratory laparotomy with a ventral median celiotomy approach was scheduled. Duodenal enterotomy was performed near the papilla, and a sample of the bile was collected through cannulation of the cystic duct for bacteriological examination (bacteriological culture was negative). A choledochotomy was performed, and the pancreatic duct was visualised. The pancreatic duct was cannulated, and intraoperative ultrasonography was used to precisely locate and remove the pancreatolith (Figure 2). The cat recovered uneventfully, and US exam 1 year later showed persistence of mild pancreatic duct enlargement without pancreatolith and peripancreatic steatites. Feline pancreatolithiasis formation is rare, and the underlying pathophysiological mechanisms are unclear.1-3 In people, pancreatolithiasis is associated with chronic pancreatitis. This report highlights the usefulness of a multimodal imaging approach (preoperative US and CT, intraoperative US) for the management of feline pancreatolithiasis. Moreover, a possible association between pancreatolithiasis and suspected triaditis in a cat was reported. Federica Valeri: Conceptualisation; investigation; data curation; writing—original draft preparation; writing—review and editing. David Forti: Investigation; data curation, writing—review and editing. Giovanni Angeli: Investigation; data curation; writing—original draft preparation; writing—review and editing. Lisa Garofanini: Investigation; data curation; writing—review and editing. Giulia Moretti: Conceptualisation; investigation; data curation; writing—original draft preparation; writing—review and editing. We thank Prof. Domenico Caivano for his help in describing the present case. Open access publishing facilitated by Universita degli Studi di Perugia, as part of the Wiley - CRUI-CARE agreement. The authors declare they have no conflicts of interest. The authors received no specific funding for this work. As a retrospective case report, no institutional ethical committee approval was necessary. Figure 1A shows an ultrasonographic image of the right lobe of the pancreas with a hyperechoic structure within the mildly dilated pancreatic duct. Considering Figure 1A, what is the likely diagnosis? A. Pancreatic cyst B. Pancreatic abscessation C. Pancreatic nodule D. Pancreatolithiasis E. Cholelithiasis D. Pancreatolithiasis. The ultrasonographic findings of the hyperechoic structure accompanied by strong acoustic shadowing within the pancreatic duct are suggestive of pancreatolithiasis. Pancreatic cyst, abscessation or nodule shows a different pattern. Cholelithiasis presents similar findings, but within the gall bladder or biliary tract.