Case Study

Perforated Gallbladder Mucocele in a 12 year old MN Maltese dog

A 12-year-old NM Maltese with a history of pituitary dependent hyperadrenocorticism that was being treated with Lysodren was presented for vomiting, anorexia and not doing well over a 2-day period. Urinalysis showed an inappropriate SG (1.018), proteinuria, and bilirubinuria. Abnormalities on CBC and serum biochemistry were leukocytosis, severely elevated ALT and severely elevated ALP activity, hypoalbuminemia, bilirubinemia, and azotemia. The patient was treated with antibiotics, to which there was some response.

A 12-year-old NM Maltese with a history of pituitary dependent hyperadrenocorticism that was being treated with Lysodren was presented for vomiting, anorexia and not doing well over a 2-day period. Urinalysis showed an inappropriate SG (1.018), proteinuria, and bilirubinuria. Abnormalities on CBC and serum biochemistry were leukocytosis, severely elevated ALT and severely elevated ALP activity, hypoalbuminemia, bilirubinemia, and azotemia. The patient was treated with antibiotics, to which there was some response.

DX

Perforated gallbladder mucocele

Sonographic Differential Diagnosis

Inflamed, perforating gallbladder mucocele with adhesions and common bile duct dilatation.

Image Interpretation

The liver was swollen in contour with mild increase in the portal markings and a severely inflamed gallbladder mucocele with adhesions and positive Murphy’s sign with a slight amount of free fluid noted between the stomach and gallbladder. The common bile duct presented minor dilation at 0.5 cm with an echogenic material in the last 3.0 cm of the common bile duct prior to the duodenal papilla. This is most consistent with a bile plug.

Outcome

Coagulation panel and immediate cholecystectomy and common bile duct lavage with potential for common bile duct deviation may be necessary. Liver biopsy and gallbladder culture is indicated.The patient went to a specialty hospital and had gallbladder removed, cystotomy and mass on back removed. The patient is currently doing well.

Clinical Differential Diagnosis

Lysodren-induced Addison’s disease Liver pathology -bacterial/viral hepatitis, toxic, neoplasia, hyperadrenocorticism Gall bladder patholog – mucocele, cholecystitis, obstruction