Sonopath Forum

Cholangiohepatitis vs bile duct neoplasia

7 year FS DSH cat, outdoors-stray who presents with decreased apetite for 2-3 days. Mildly Dehydrated, no info about V-D-drinking, urine nor much more than this. After 2nd day in hospi appears bright and regaining a bit of apetite.

-Biochem: ALP, ALT and TBIL sky high. Jaundiced. UA not done.CBC nothing significantly off.

-Ultrasound: Liver: very irregular parenchymal echogenicity with diffuse hyper/hypoechogenic areas. No discrete lesions. Intrahepatic biliary ductal dilation with some echogenic shadows moving when breathing. Distended GB with some echogenic bile, no stones seen. Dilated cystic duct as well as CBD. CBD lumen presents mild echogenic specks and walls are very thickened measuring approx 0.3cm (photo). The dPAP appears mildly enlarged with a mildly atrophied muscularis layer (photo). Pancreas mildly hypoechoic, no ductal dilation, no discrete nodules/lesions. There is pericystic inflammation around cystic duct, Gb and CBD as well as inflammed hyperechoic mesentery around DPAP liver/duodenum/pancreas area.

-Kidneys: mild mineralization in CM junction. No other significant findings. No enlarged LNs that I could see. GIT fairly normal, mildly thickened and echogenic submucosa that I consider a bit imflammatory rather than infiltrative.

-Questions: my differentials include acute -turning chronic cholangiohepatitis, cholecystitis, ductal neoplasia (CBD carcinoma…?). Does this look neoplasia? I have not seen many of these cases and these clips appear pretty abnormal and impressive so in my head Im thinking neoplasia rather than inflammation…(?). I would advice biopsy once patient stable but…is this a case for cholecystectomy? and CBD resection??…I would think so…Finally, I have been asked twice by my colleagues if this could be flukes…and I do not know whether I would see the parasites or not. I do see some rather strange things in intrahepatic biliary ducts only I assumed it would be stagnant bile…???

Thanks for any input.