hI, I have another cat with potentially abnormal CBD…or tortuous PV…
So, this is a 7y old FN DSH with long history of vomiting and being treated initially for stomatitis and in the last few days for Pancreatitis with abnormal fPlipase. Biochemistry shows normal Tbil.
hI, I have another cat with potentially abnormal CBD…or tortuous PV…
So, this is a 7y old FN DSH with long history of vomiting and being treated initially for stomatitis and in the last few days for Pancreatitis with abnormal fPlipase. Biochemistry shows normal Tbil.
US: hyperechoic liver, no discrete masses. Hypoechoic pancreas no obvious pancreatic duct dilation. No obvious masses in pancreas. ICCJ: abnormally thickened muscularis (hypoechoic loss of mural detail). regional Lns are enlarged and hypoechoic, slightly irregular on their way to losing oval shape. There are few other enlarged hypoechoic mesenteric Lns and very prominent and visible Peyers Patches…
Now…there is a ductal structure that to me…it very much appears to be PV due to clear flow on doppler and RBCs flow without it…however, it appears tortuous, so I wonder whether it could be CBD. I can identify an echogenicity in pancreatic papillae but without distal echoshadowing… So basically, I cant quite discern whether there is a bile obstruction and whether this papillae is abnormal. The GB does not seem so distended to me…
EL:Im trying to get out of the “ham and egg” group into the “big boy scanning” group…but still not quite ready, I see;p Thank you for your explanations about following the CBD. I did try in this case…my common sense says this may be CBD with an obstructive disease at papillae…my doppler says there is flow in that dilated duct…Any help? Im scanning again tomorrow to monitor potential CBD dilation.
Thanks for any input.
Comments
So, just to update… I
So, just to update… I re-scanned today and that’s is PV and not CBD. The CBD is 0.24cm. There is still no signs of pancreatic duct dilation, neither.
The duodenal papilla appears just the same and there is no distal shadowing. The papillae and the ICCJ are extremely painful, whereas the rest of exam she is very relaxed.
The cat is actually much older than 7y old.
I think there is some Lymphoma cooking.
Any extra ideas?
Thanks for the followup…
Thanks for the followup… just a tortuous pv. PV velocities under 18 cm/sec would suggest portal hypertension but the liver doesnt look bad… maybe just an anomaly thing…. its a cat they are very good at anomalies:)
I dont see anything saying lsa on these images but sometimes a shopping spree of FNA spleen and liver pop up something even if the organs are nsf.
Thanks, EL.
But… Do the
Thanks, EL.
But… Do the papillae and ICCJ appear normal? I didn’t thing they looked normal. For the papillae, I don’t get to see many of them cause I not always get it. For the ICCJ I thought it was quite hypoechoic and thickened in comparison to other normal ones…
We will keep monitoring and see how it goes.
I searched for normal papillae in the engine but the I don’t see many normal…
Thanks again
Silvana
Older cats get thickened
Older cats get thickened d-paps over time but this is stable and not expansive. Here are some normal young d-paps in a dog and a cat that I have handy. The cat image had a structured d-pap here with secondary cbd dilation > 0.4 cm.
Ahhhhh! Right… Now it looks
Ahhhhh! Right… Now it looks normal to me:) thanks for that. In the end, in just glad I checked the patient again. That gave me peace of mind too. Thanks for your help!! Very instructional, as usual.