- 16 yr old FS DSH presenting for anorexia, weight loss, elevated ALT>1000, elevated TBil (0.6).
- Is on methimazole for hyperthyroidism but not well controlled right now, and hypoallergenic desensitization therapy.
- Cat had an episode of cholangiohepatitis 2 and 1/2 years ago (coarse liver parenchyma and dilated pancreatic duct) that responded to medical management but this time round the ultrasound findings are more dramatic.
- 16 yr old FS DSH presenting for anorexia, weight loss, elevated ALT>1000, elevated TBil (0.6).
- Is on methimazole for hyperthyroidism but not well controlled right now, and hypoallergenic desensitization therapy.
- Cat had an episode of cholangiohepatitis 2 and 1/2 years ago (coarse liver parenchyma and dilated pancreatic duct) that responded to medical management but this time round the ultrasound findings are more dramatic.
- Abdominal US shows an enlarged , hypoechoic pancreas with a dilated pancreatic duct (2-4.5mm) pancreatic cysts, and adjacent, echogenic fat, small intestinal segments with an increased muscularis to mucosal ratio and adjacent, echogenic fat, full gallbladder with a slightly thickened wall and tortuous cystic duct, periportal lymphadenopathy, and a hypoechoic spleen with an irregular capsule.
- My primary differential is triaditis, but I am concerned about the severity of the pancreatic duct dilation and the new finding of pancreatic cysts (emerging neoplasia?)
- I am attaching images of the pancreas and portal hilus region.
Comments
Lots of chronic pancreatic
Lots of chronic pancreatic changes, cysts, enlargement but spleen big too… either reactive or infiltrative. I would fna spleen and liver and panc and see what comes up. Likely triad cat wiht panc being the main player now but I never like a spleen > 1 cm in a cat… spleen gets bigger in cats when reacting to pancreas but this is big enough for a 25g fna. If the bili is going up then fna liver too but I see post-hepatic obstruction here wihth the dilated CBD in video 1… structured off from panc likely. Single dose dexameth may do the trick to reduce inflammation but sample first.
Thanks, Eric!
Thanks, Eric!