Hi everyone,
Ive got a ‘head scratching’ case and I was hoping i could get some expert opinions on this. Beetle is a 13 year old, male neutered, welsh terrier that was presented for Polyuria and Polydipsia. Bloods were done which showed ALT 1000IU/L, ALP 1003IU/L and GGT was mildly increased at 9 IU/L. Total bilirubin was within normal limits.
Hi everyone,
Ive got a ‘head scratching’ case and I was hoping i could get some expert opinions on this. Beetle is a 13 year old, male neutered, welsh terrier that was presented for Polyuria and Polydipsia. Bloods were done which showed ALT 1000IU/L, ALP 1003IU/L and GGT was mildly increased at 9 IU/L. Total bilirubin was within normal limits.
There was an oval shape hyperehoic mass that was seen invading the common bile duct. Moreoever, the common bile duct was observed to be diffusedly dilated. There was no mass observed at the level of the duodenal papillae. Based on the location of this mass, it could be a hepatic lymph node, liver tumour or a pancreatic tumour. Both adrenal glands were enlarged. I know phaeochromocytoma are known to invade major vessels however, I do not know any masses to invade the common bile duct?
Question:
What type of tumours invade the common bile duct?
Is it safe to performed a biopsy on this mass?
Comments
These are usually bile duct
These are usually bile duct carcinomas and can be slow growing and as long as bile squeaks through the slow plumbing wiht an in tact d-pap the bili stays normal in the serum. 25g fna should be diagnostic and fna any sort of liver nodule as the mets are often isoechoic and best detectable with 12 mHz or higher. Big bile sludge plug possible too but less likely. You can tell the difference between mass and bile plug by putting powerdoppler on it as the mass will show blood flow.
Here are some similar case in the basic search
http://sonopath.com/members/case-studies/cases/0300430-baby-b-bile-duct-neoplasm-ehbdo
http://sonopath.com/members/case-studies/cases/extra-hepatic-bile-duct-obstruction-mass-duodenal-papilla-8-year-old-mn-b
but search pancreatic carcinoma too as it will envelop the common bile duct causing EHBDO usually from the outside whereas yours is clearly within the cbd.
Ahhh… thanks Eric! Always
Ahhh… thanks Eric! Always a big help! 🙂 I’ve never seen one before! very interesting!
Ahhh… thanks Eric! Always
Ahhh… thanks Eric! Always a big help! 🙂 I’ve never seen one before! very interesting!
You are welcome… keep
You are welcome… keep scannign that CBD there is a lot of occult pathology there… stones, mucoducts, carcinomas and inflammatory proliferaive tiessue with all of the above at times.
More on biliary parameters clinically check out our research on it… its a bit different than you would traditionally expect:
http://sonopath.com/resources/research-publications
Defining a GB mucocele and clinical parameters of biliary disease ecvim 2009.
Very nice images –
Very nice images – interesting case!
No way!!
I went back to
No way!!
I went back to reassess my images of the gall bladder and it didn’t seem connected to the ‘mass’. In addition, the gall bladder did not present with the characteristic stellate patterns we see in mucocele. What a weird case!!
Huh they didnt look attached
Huh they didnt look attached either… must have been an odd angle