This case was discussed in virtual Abdominal Rounds with Donald E. Thrall DVM, PhD, DACVR in January 2021.
If you haven’t yet attended these virtual rounds sessions and are interested in joining us, please ask to be added to the list. We look forward to seeing you online!
History: Straining in the litter box. Not urinating for 24 hours, then lethargic. Mostly outdoors.
Imaging: Lateral and ventrodorsal radiographs of the abdomen were acquired.
- The urinary bladder is mildly distended. The opacity of the urinary bladder is homogeneous. There is no evidence of cystic or urethral calculi. There is no evidence of a urethral plug.
- There is a nodular appearance to the fat stores in the retroperitoneal space, inguinal region, mesentery and subcutaneous regions.
- There is reduced acetabular coverage of the femoral heads bilaterally and a large osteophyte on the cranial margin of the right acetabulum.
- There is no evidence of urolithiasis. This does not rule out non-mineralized calculi or soft tissue lesions of the urinary tract. A cause of the straining was not identified.
- There could be pain associated with posturing to urinate as a result of the coxofemoral osteoarthritis however this is not definitive.
- The nodular appearance to the fat stores is concerning for steatitis, possibly associated with vitamin E deficiency. Artifact associated with the image processing algorithm is not likely given the heterogeneity of the nodular appearance.
There is not a definitive diagnosis of pansteatitis in this patient but the similarity in appearance provides an opportunity for discussion of this uncommon syndrome. (Niza, Vilela, & Ferreira, 2003). Pansteatitis results from inadequate Vitamin E, which is a potent antioxidant. Inadequate Vitamin E can be due to inadequate dietary intake but overconsumption is more common. For example, ingestion of high levels of unsaturated fatty acids, such as in oily fish species, depletes Vitamin E. Without the antioxidant effects, unsaturated fatty acids in the lipids of cellular membranes are very vulnerable to oxidative damage, thus leading to peroxide formation. These reactive peroxides result in fat necrosis.
The clinical signs of pansteatitis are vague but include fever, lethargy, inappetence, and, most notably, pain on palpation of the skin. As mentioned above, there is not a definitive diagnosis of pansteatitis in this patient, and there was no mention of pain upon palpation, but the radiographic appearance should at least suggest the possibility of this rare condition with investigation of the diet.
Niza, M., Vilela, C., & Ferreira, L. (2003). Feline pansteatitis revisited: hazards of unbalanced home-made diets. Journal of Feline Medicine and Surgery, 5, 271-277.