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.
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.
Comments
Searchign CBD dilation int he
Searchign CBD dilation int he search engine comes up wiht a ton of these cases with the variable presentations and causes
http://sonopath.com/members/case-studies/search?text=CBD+dilation&species=All
Nice image set! The cbd in your case is uniformly thickened all the way to the d-pap which is most consistent with chronic cholangitis. The curvilinear patterns of the cbd wall are maintained even if thickened. When cbd neoplasia happens curvilinear patterns of the wall are distorted, become polypoid and disorganized. The d-pap is thick but pinched down and no plug there like a stone or tumor.
Just a reminder try to stick to quick bullet point history so we can get through your post efficiently.
Thank you! I’m glad it looks
Thank you! I’m glad it looks benign since owners unlikely to go for any surgery.
With regard to the flukes question, I know we can test feces and treat but, would this be a presentation compatible with flukes infestation?
Sorry about long history. I’ll try an summarize better next time.
I have yet to see flukes in
I have yet to see flukes in the cbd given I’m in NJ and havent seen one on telemed yet. Anyone else out there have liver fluke images? From what I understand its a cholhep scenario so if you have them in the area then testing and treating empirically would be prudent I would think.
What is reported is that
What is reported is that serum biochemistry and abdominal ultrasound is suggestive of extra-hepatic biliary obstruction, which would fit what this cat is showing. According to the literature, in the USA, it has has been reported in Florida and Illinois.
Liver fluke eggs on fecal
Liver fluke eggs on fecal examination.
A more recent
A more recent article:
Percutaneous Ultrasound-guided Cholecystocentesis and Bile Analysis for the Detection of Platynosomum spp.-Induced Cholangitis in Cats.
Availabe at: http://onlinelibrary.wiley.com/store/10.1111/jvim.13943/asset/jvim13943.pdf?v=1&t=imq4ukdt&s=6b7a16a7db3b8405858cd73efad0cc7e14bb4399
OH! Sorry I had not seen
OH! Sorry I had not seen these last posts until now!. Very greateful for the info and links. Thanks so much!