Case Study

Possible hepatic abscess in a 12 year old FS English Springer Spaniel dog

A 12-year-old FS English Springer Spaniel dog was presented for acute onset of vomiting. Physical exam found the dog to be pyrexic at 104.7F and dehydrated, with a painful abdomen. Blood chemistry revealed mild elevations in the liver enzyme activities. Abdominal radiographs showed decreased detail.

A 12-year-old FS English Springer Spaniel dog was presented for acute onset of vomiting. Physical exam found the dog to be pyrexic at 104.7F and dehydrated, with a painful abdomen. Blood chemistry revealed mild elevations in the liver enzyme activities. Abdominal radiographs showed decreased detail.

DX

Possible hepatic abscess

Sonographic Differential Diagnosis

The lesion in the liver is concerning for hepatic abscess especially in light of fever. But the lesion structurally could also be due to a cyst, which could be blood filled or filled a transudate of fluid. This may also represent an early neoplastic lesion such as early hepatocellular carcinoma or hemangiosarcoma. However, given the fact that the dog was painful over this region and that there was hyperechoic tissue surrounding it and persistent fever, I am concerned about the possibility of an abscess.

Image Interpretation

The liver was mostly homogenous and normal in echogenicity. There was a cystic, anechoic lesion in the left cranial liver just caudal to the diaphragm with a hyperechoic rim noted around it. This region was painful. This structure measured 2.75 x 3.06 cm. The gallbladder was normal and there was no evidence of any masses, choleliths, or sludge within the gallbladder. The bile duct did not appear to be dilated.

Outcome

Further diagnostics including a spec CPL was advised. A fine needle aspirate was offered but not performed. I.V. fluids, antibiotics, anti-emetics, analgesics, gastro-protectants, and a possible plasma transfusion were suggested as therapies for this patient. Exploratory surgery was not a feasible option due to the location of the lesion in the cranial liver just caudal to the diaphragm in the left quadrant.

Comments

The patient was lost to follow-up. Owing to technical difficulties, no video is available on this patient.

Clinical Differential Diagnosis

Multi-organ pathology – Chronic active hepatitis, mucocele or cholelithiasis and secondary cholangiohepatitis, pancreatitis with secondary cholestasis and/or cholangiohepatitis, neoplasia affecting the liver (hepatocellular adenoma, lymphoma, adenocarcinoma, histiocytic sarcoma, mast cell tumor.)