Case Study

Mass in the neck of the gall bladder extending into the pancreas in a 10 year old MN DSH cat

This 10-year-old MN DSH presented for anorexia and lethargy over the previous two days. The physical exam revealed a mildly painful cranial abdomen and jaundice. The CBC demonstrated a mild leukocytosis with a left shift. The blood chemistry showed moderately elevated ALT, mildly elevated ALP and AST, moderately elevated amylase, and moderately elevated bilirubin. The urinalysis demonstrated 3+ bilirubinuria but was otherwise normal.

This 10-year-old MN DSH presented for anorexia and lethargy over the previous two days. The physical exam revealed a mildly painful cranial abdomen and jaundice. The CBC demonstrated a mild leukocytosis with a left shift. The blood chemistry showed moderately elevated ALT, mildly elevated ALP and AST, moderately elevated amylase, and moderately elevated bilirubin. The urinalysis demonstrated 3+ bilirubinuria but was otherwise normal.

DX

Mass extending from the gall bladder to common bile duct and the pancreatic body

Sonographic Differential Diagnosis

Post-hepatic biliary mass with likely contiguous pancreatic spread. Suspect biliary carcinoma or similar neoplasia.

Image Interpretation

An echogenic to isoechoic mass was found penetrating the cystic duct, gall bladder, and common bile duct to the point of the pancreatic duct. Similar nodular echogenic changes at the right pancreatic base adjacent to the pyloric outflow would suggest a contiguous metastatic process. Slight free fluid in the portal hilus region would suggest bile leakage or potential transudate formation from lymphatic obstruction. Transdiaphragmatic view of the lung fields show pleural irregularities (“comet tails”) which may mean concurrent metastatic lung disease.

Outcome

The patient was euthanized by owner request on the surgical table after being offered an attempt at cholecystoduodenostomy with extremely guarded prognosis.

Clinical Differential Diagnosis

Cholangitis, hepatic lipidosis, biliary obstruction, pancreatitis, neoplasia, IBD.

Sampling

Exploratory surgery was performed and confirmed the type and position of a mass extending from the gall bladder to common bile duct through the mesoduodenum to the pancreatic body. The gall bladder wall was thickened but friable and filled with thick mucous debris. Concurrent pancreatitis and bile peritonitis was present due to a minor biliary leakage from the CBD.