Case Study

Pyogranulomatous cholangiohepatitis, extramedullary hematopoiesis in a 4 year old FS Pomeranian dog

A 4-year-old FS Pomeranian presented for diarrhea and weight loss. Physical examination revealed low body condition score and a mild fever that was non-responsive to antibiotics over the previous 72 hours. CBC showed a severe and highly regenerative anemia with schistocytosis. The blood chemistry analysis was normal.

A 4-year-old FS Pomeranian presented for diarrhea and weight loss. Physical examination revealed low body condition score and a mild fever that was non-responsive to antibiotics over the previous 72 hours. CBC showed a severe and highly regenerative anemia with schistocytosis. The blood chemistry analysis was normal.

Sonographic Differential Diagnosis

Inflammatory or granulomatous disease and neoplasia.

Image Interpretation

Transverse view of the left liver demonstrates mildly hepatic enlargement represented by the presence of distended, rounded, slightly undulating serosal margins (arrow) with a poorly circumscribed, multi-nodular hepatic echotexture.

DX

Pyogranulomatous cholangiohepatitis, extramedullary hematopoiesis, Histoplasma capsulatum visualized

Outcome

The patient expired suddenly 72 hours after diagnosis.

Comments

Splenic FNA provided similar results. This patient had moved from an endemic area for histoplasmosis to the Northeast United States at 4 months of age.

Clinical Differential Diagnosis

GI pathology: Infectious disease, diffuse inflammatory GI disease, GI obstruction, neoplasia.

Sampling

22-gauge US-guided FNA revealed pyogranulomatous cholangiohepatitis and extramedullary hematopoiesis. Histoplasma capsulatum was visualized.

Video

Patient Information

Patient Name : Cuddles P

Gender : Female, Spayed

Species : Canine

Type of Imaging : Ultrasound

Status : Complete

Liz Wuz Here : Yes

Code : 03_00065

Clinical Signs

Diarrhea
Weight loss

Exam Finding

Fever
Weight loss

CBC

RBC, Low

Clinical Signs

Diarrhea
Weight loss