This is a 13 y old FN pomeranian cross presented for collapse. Liver enzimes elevated. had been vomiting previous day.

This is a 13 y old FN pomeranian cross presented for collapse. Liver enzimes elevated. had been vomiting previous day.

US findings: slightly diffusely hyperechoic liver parenchyma and portal veins atenuation but no discrete lesions. Normal portl/hepatic vasculature. GB: rather small, thick hyperechoic wall with strongly echogenic foci with distal echoshadowing in some views. No movement uppon re-positioning of patient. some non-mobile echogenic content. No marked hyperechogenic surrounding liver parenchyma but the surrounding cystic fat appears hyperchoic and extends all around duodenal/pancreatic body area. No regional free fluid nor enlarged LNs other than what it seems to be the Pancreatico-duodenal Ln (round and hypoechoic). CBD is not dilated and there are no signs of intra/extrahepatic biliary obstruction.

Pancreas: Body and proximal R limb appear ill defined.

Desc Duodenum: thickened diffusely hyperechoic mucosa. Muscularis and serosal detail preserved.

There is pain and discomfort at probe preassure of any part of the right cranial quadrant.

My differentials include: chronic hepatitis, cholecystitis with mineralization/calculi in the wall, possible regional bile peritonitis, pancreatitis vs neoplasia (due to enlarged LN) and duodenitis vs neoplasia infiltration (less likely-due to preserved mural detail).

owner declined any sampling. and case was reffered for overnight hospitalization. I will enquire about this case this monday.

Questions:

1- What other differentials to consider?

2- Am I right to consider bile leak as an option? Is that pericystic fat abnormally hyperechoic like I think? I’m surprised the Gb is so small so I called it a forming imflammed mucocele. But it may just be plain cholecystitis?

3- What are your views on sampling the Gb for culture? When to do and when not to do?

Thanks for any input.