Case Study

03_00354 Charlie D Possible cirrhosis

A 5-year-old NM poodle was presented for evaluation of chronic weight loss and reduced appetite. On physical examination, weight loss was evident. Urinalysis showed bilirubinuria, proteinuria, and normal SG. Abnormalities on serum biochemistry were elevated liver enzyme activity and bilirubin, and low normal albumin.

Sonographic Differential Diagnosis

Portal hypertension owing to diffuse, nodular hepatic disease. This is strongly suggestive for hepatic cirrhosis and fibrosis. Chronic inflammatory hepatopathy.
The primary issue appears to be liver disease with concurrent protein losing nephropathy. Infectious agents such as tick borne disease and Leptospirosis may also be playing a role in this case. Liver biopsy is recommended in this patient. Prognosis is poor. Plasma transfusion is recommended along with coverage for Leptospirosis with IV Ampicillin, Doxycycline and gastrointestinal protectants. Coagulation panel is recommended prior to the biopsy. Blood pressure measurements are warranted.

Image Interpretation

The liver was coarse in architecture with increased portal markings and echogenic remodeling and micro and macronodular changes with surrounding, hyperechoic fat. The portal vein was prominent with subnormal portal vein velocity (18 cm/sec). Periportal lymphadenopathy was also present that measured 2 x 5 cm. The gallbladder presented inspissated debris, yet was not considered a mucocele formation. The gallbladder wall was mildly thickened.