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Duodenal papilla

Sonopath Forum

Sonopath Forum

Duodenal papilla

  • 12 year old MN Fox Terrier presented inappetant with abdominal pain
  • Bloods showed severe elevation of liver enzymes, tbil (>300), cholesterol, lipase
  • Scan showed heterogenous/nodular liver, cystic/thickened gallbladder wall, distended CBD and pancreatitis
  • (Also has a few hypoechoic splenic nodules, renal and bladder calculi and a mineralised left adrenal mass)
  • I am concerned that the duodenal papilla is thickened and this appears to be causing the CBD distension. Does this look neoplastic?

  • 12 year old MN Fox Terrier presented inappetant with abdominal pain
  • Bloods showed severe elevation of liver enzymes, tbil (>300), cholesterol, lipase
  • Scan showed heterogenous/nodular liver, cystic/thickened gallbladder wall, distended CBD and pancreatitis
  • (Also has a few hypoechoic splenic nodules, renal and bladder calculi and a mineralised left adrenal mass)
  • I am concerned that the duodenal papilla is thickened and this appears to be causing the CBD distension. Does this look neoplastic?

Comments

DrMac
July 14, 2019 at 11:17 pm -

I’m seeing maintained and

I’m seeing maintained and discernable, intact wall layering although a focal area of what looks like the pylorus or upper duodenum exhibits muscularis hypertophy in the first clip. I suspect this is due to the pancreatitis. There is marked CBD dilation appraching the duodenal papilla so there is potential for obstruction at the level of the papilla. 

I think this looks more inflammatory than neoplastic with the maintained wall layering but there is potential for neoplasia. With the severe liver enzyme elevation, TBIL, and the marked CBD dilation, surgery with CBD and papilla flushing or other procedures to make sure of patency along with biopsies may be ideal for definitive diagnosis but may not be possible with the other things going on with this dog. 

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