NODULAR FAT NECROSIS IN THE FELINE AND CANINE ABDOMEN

TOBIAS MA, DR. MED.VET.,FEDERICA

SCHWARZ, MORANDI,DVM, GIACOMO DR. MED.VET.,
GNUDI,
ERIKWISNER,
DVM, CALUM MSc, MARTINSULLIVAN,
PATERSON, BVMS, PHD,
PAMELA BVM&S, PHD
JOHNSTON,

The radiographic appearance of nodular fat necrosis is described in ten cats and one dog. The most
common radiographic sign was the presence of a focal mineralized circular to oval soft tissue mass in
the abdominal fat as present in 9 cats. These masses had a distinct eggshell-like rim encapsulating the
lesion. In one cat and one dog multiple masses were present, without radiographic signs of mineral-
ization. Abdominal ultrasound was performed in three cats and one dog, findings included the presence
of hyperechoic masses with associated acoustic shadowing, some with a hypoechoic centre. Almost all
animals were old and obese. In three cats and one dog, changes were confirmed with biopsy or post
mortem examination. Lesions having the appearance of those in this paper are most likely incidental
findings and should not be confused with abdominal masses of neoplastic origin. Ultrasound can be
helpful in identifying such lesions. Veterinary Radiology & Ultrasound, Vol. 41, No. 4, 2000, p p 335-339.

Key words: nodular fat necrosis, canine, feline, pancreatitis, steatitis, lipomatosis, omental cyst, mes-
enteric cyst, radiography, ultrasound

Introduction

radiographic and ultrasonographic appearance of nodular fat

T HE ABILITY to distinguish abdominal organs in the dog
and cat radiographically is mainly dependent on fat de-
position around the organs as they are largeIy soft tissue in
necrosis in the cat and dog.

composition.' Apart from lack or loss of intra-abdominal fat
or accumulation of peritoneal fluid causing ablation of the
fat opacity, pathologic changes to the fat itself can lead to
alteration in its opacity resulting in decreased abdominal
detail. Ill-defined patchy areas of soft tissue opacity, repre-
senting inflammation, fat necrosis and saponification have
been reported in acute pancreatitis and nutritional diseases
such as steatitis in Fat necrosis may also occur as an
encapsulated lesion within the abdomen of large and, more
rarely, small animal^.^ There is anecdotal evidence, that this
form of fat necrosis is visible on abdominal radiograph^.^
The purpose of this multi-center study was to describe the
Materials and Methods
The abdominal radiographs of ten cats and one dog with
radiographic signs of soft tissue opacity or mineralized foci
within the abdominal fat were evaluated. The clinical
records of all animals were reviewed. Lesions were mea-
sured on lateral radiographs and the degree of mineraliza-
tion subjectively assessed by two reviewers as absent, mod-
erate or marked. In the same manner, the amount of ab-
dominal fat was staged normal, moderate or severe. In three
cats and one dog, abdominal ultrasound examination was
also performed. In three cats and one dog a biopsy or post
mortem examination was carried out.

From the Department of Veterinary Clinical Studies (Schwarz, Sulli-
van), Veterinary Anatomy (Paterson) and Veterinary Pathology (Johnston),
University of Glasgow, Bearsden Road, Glasgow G61 lQH, SCOTLAND,
UK; the Department of Veterinary Clinical Sciences, College of Veterinary
Medicine, The Ohio State University, 601 Vernon L. Tharp Street, Coluni-
bus, OH 43210, USA, (Morandi, Wisner) and the Istituto di Radiologia
Sperimentale, Facolth di Medicina Veterinaria, Universith degli Studi di
Parma, Via del Taglio, 8, 43100 Parma, ITALY (Gnudi).
Address correspondence and reprint requests to Dr. Schwarz at the ad-
dress above.
Received July 12, 1999; accepted for publication November 3, 1999.
Results
There were five neutered male cats, two intact male cats,
three neutered female cats and one neutered female dog.
The age ranged from 5 to 17 years with a mean age of 10.8
years. Clinically, all animals were obese, and 7 were con-
sidered severely overweight. In eight cats and one dog there
was a history or confirmed diagnosis of urinary tract dis-
ease. There were 3 patients with chronic renal failure, 5 cats
with cystitis/feline urological syndrome, one cat with anti-

335
336
coagulant associated hematuria. The dog presented with uri-
nary incontinence.
The common radiographic feature was the presence of
one focal circular to oval mineralized soft tissue mass em-
FIG. 1. Lateral (A) and ventrodorsal (B) abdominal radiographs of an
11-year-old obese male neutered domestic short hair cat with a 16 mm
ovoid mass in the mid caudoventral abdomen. The lesion is demarcated by
a markedly calcified capsule with an egg-shell like appearance.
SCHWARZ
ET AL. 2000
bedded within intra-abdominal fat (Fig. 1, 2). In 6 cats
mineralization was marked, in 3 cats it was moderate, in one
cat and the dog absent. Mineralization took the form of a
fine eggshell-like calcified rim, with inner striations. How-
ever, in one cat and one dog lesions were multiple, with
at least 6 masses that showed no radiographic signs of
mineralization. Diameter of these masses ranged from 5 to
40 mm, but most were between 8 and 20 mm. Solitary
masses were located in the area of the falciform ligament
in four cats and in the tail of the omentum near the apex
of the bladder in five cats. There was a widespread distri-
bution in one cat and one dog with multiple lesions (Fig. 3).
In three cats and one dog in which an ultrasound exami-
nation was performed, no masses were detected in two
cats. In one cat a hyperechoic focus with associated acoustic
shadowing was present in the mid-abdomen. In the dog,
6 hyperechoic masses with acoustic shadowing were found
in the peritoneal (Figs. 4A, B) and retroperitoneal space
(Figs. 4C, D). Some masses had a hyperechoic rim and a
hypoechoic centre, producing a cyst-like appearance (Figs.
4C, D).
In the dog, clinical, radiographic, and sonographic find-
ings were regarded as significant and an abdominal neo-
plasm was suspected. An exploratory laparotomy was per-
formed and multiple hard, round, green masses with caseous
centers within the omentum were removed. In all cats the
masses were interpreted as incidental findings without clini-
cal significance.
Post mortem examination was performed in one cat with
a markedly mineralized mass. There was a 5 mm spherical
dark yellow firm mass in the mesenteric fat. A single cal-
cified lesion in another patient showed evidence of steatone-
crosis and presence of unspecified bacteria. In the dog, mul-
tiple foci of necrosis and inflammation were scattered
throughout the fat (Fig. 5). In one cat with multiple lesions,
but no radiographic evidence of mineralization, there were
microscopic areas of fat necrosis. Within the encapsulated
FIG.2. Lateral abdominal radiograph of a 17-year-old moderately obese
neutered male Siamese cat with an 8 mm ovoid mass in the cranioventral
abdomen. The lesion has a calcified rim.
VOL. 41, No. 4 NODULARFAT NECROSIS
FIG. 3. Lateral (A) and ventrodorsal (B) abdominal radiographs of a
10-yeer-old severely obese neutered female Jack Russell terrier with mul-
tiple 15 to 40 mm large circular to oval soft tissue masses throughout the
peritoneal and retroperitoneal space.
fat there were foci of mineralization and cholesterol crys-
tallization (Fig. 6).
Discussion
Fat cells are vulnerable to trauma, ischemia and local
inflammatiom6 Fat released from damaged lipocytes is hy-
drolysed to glycerine and fatty acids, which increase local
acidity and thereby produce necrosis, enhance inflammation
and can result in ~aponification.~,~ Finally, affected cells
may be replaced by fibrous tissue or become minerali~ed.~ diographs. In dogs, nodular fat necrosis is either more rare
331
In contrast to disseminated enzymatic fat necrosis in acute
pancreatitis and other more generalized conditions such as
steatitis and lipomatosis, the etiology and pathogenesis of
nodular intra-abdominal fat necrosis is most obscure. It does
occur frequently in sheep and sometimes in horses, pigs and
other specie^.^ Since affected animals are typically very
obese, the focal nature of the lesions has been hypothesized
to be due to pressure ischemia caused by differences in
texture and composition of the fat or circulatory deficits in
the small capillaries nourishing the faL4 Intracellular lipoly-
tic disturbances associated with fat mobilization is another
h y p ~ t h e s i sSimilar
.~ changes in the subcutaneous fat (nodu-
lar panniculitis) are relatively common in animals and man,
being caused by factors such as infection, allergy, immune-
mediated diseases, trauma, subcutaneous injection, pancre-
atitis, glucocorticoid therapy, vasculitis, malnutrition, en-
teropathies and idiopathic disease.798In all cats presented
here, nodular intra-abdominal fat necrosis was an incidental
finding in obese and almost always old animals. Obesity and
the high incidence of urinary tract disease may be related to
the neutered status of the animals. We could not find a
clinical association between the urinary tract disease and the
fat necrosis in this study. There is anecdotal evidence that
nodular fat necrosis can be seen on radiographs of older
cats. One radiographic report mentions mesenteric fat ne-
crosis or, possibly, chronic peritonitis as a cause of intra-
abdominal calcification with an illustration of an ovoid min-
eralized mass in a cat similar to those reported here.5 An-
other inass was irregularly and partially calcified, being
located in a peritoneal hernial sac of a dog.s It is interesting
to note that these mineralizations occur in perineal hernias,
because mesenteric and periproctal fat necrosis is often
found in this condition and can be explained by entrapment
of fat tissue.' The varied terminology used in the literature
(calcified necrotic mesenteric fat,' mesenteric/omental
cysts") and the radiologists' reports (Bate's body, Bates
body, Bates ,floater, cholestroma) used to describe the le-
sions illustrated herein attests to the lack of knowledge of
the underlying etiology and pathophysiology. Omental
cysts are rare findings in humans and extremely so in ani-
mals.' Their etiology is obscure, but they are fluid filled
structures (serum, blood) and do not mineralize. One ultra-
sonographic report mentions multiple mesenteric cysts, ap-
parently arising in remnants of a vitelline artery, in a dog
with an intussu~ception.~~ Such features were not found in
the biopsy/post mortem material in this study. We are un-
able to provide an explanation for multiple masses not being
mineralized. In other animals radiographic evidence of min-
eralized fat necrosis is mentioned in a rabbit14 and in deer,
where irregular mineralizations were found in eight of fif-
teen affected females with palpable firm sublumbar masses
due to fat necrosis. l 5 The distinct mineralized encapsulation
of such masses in cats is relatively easy to identify on ra-
338 SCHWARZ ET AL. 2000

FIG.4. Abdominal sonograms (3.5 MHz) (A & C) and associated illustrations (B & D) from the dog. (A) There is a 30mm large hyperechoic mass (M)
with marked acoustic shadowing (AS) in the mesenteric fat. (C) The mass has a hypoechoic centre (*), and is located in the retroperitoneal fat adjacent
to the left kidney (K).

FIG.5. (A) Photomicrograph of nodular fat necrosis in the same dog. Note part of a fibrous capsule (C) above areas of normal fat (F) interspersed with
necrotic debris and hemorrhage (H) (hematoxylin & eosin x 11.25). (B) Higher power view. Note the capsule (C), necrotic debris and haemorrhage (H)
(hematoxylin & eosin x 45).
VOL. 41, No. 4 NODULARFATNECROSIS
FJC.6. Photomicrograph from a cat with multiple lesions of fat necrosis
(hematoxylin & eosin x 112.5). Areas of normal fat (F) and fat necrosis are
separated by broad bands of degenerated neutrophils and macrophages.
Within the necrotic debris, areas of mineralization (arrow) and cholesterol
crystallization (c) can be seen.
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ACKNOWLEDGEMENT
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