03_00514 Dakota P Mucocele

Case Study

03_00514 Dakota P Mucocele

A 12-year-old SF Canine Mix with a history of polypnea was presented for evaluation of acute vomiting. Urinalysis showed SG 1.003. Abnormalities on CBC and serum biochemistry were leukocytosis, neutrophilia, elevated ALT activity (320,) cholesterol, severely elevated ALP (1389,) and GGT (81) activity. Survey thoracic radiographs were normal.

 

Sonographic Differential Diagnosis

Very inflamed, severe gallbladder mucocele.
Bile duct sludge.
Right adrenal nodule, likely adenoma. There is a minor potential for adenocarcinoma or pheochromocytoma.

Image Interpretation

The gallbladder in this patient was severely dilated with a periserosal inflammatory pattern and ill defined fat. This encompassed the neck of the gallbladder and entered into the cystic duct. Suspended, immobile biliary sludge was noted with areas of striations. The common bile duct was barely visible through the echogenic, ill defined fat, yet was mildly dilated at 0.7 cm. This is likely embedded with inspissated bile. Flushing the common bile duct at the time of surgery is essential. The gallbladder measured approximately 6 x 4 cm. The remainder of the liver was unremarkable other than mildly increased portal markings. The right limb of the pancreas was also inflamed with ill defined surrounding fat. This is likely an extension of the gallbladder inflammation. The right adrenal gland presented a hyperechoic, expansive nodule measuring 2.05 cm at the cranial pole and the caudal pole measured 0.63 cm and 3.67 cm in length. This is most consistent with adenoma with a minor potential for adenocarcinoma. This may or may not be functional. The left adrenal gland was uniform to slightly flattened to the isoechoic surrounding fat. The left adrenal gland measured 2.71 x 0.52 cm at the cranial pole and 0.56 cm at the caudal pole.

DX

Mucocele

Outcome

None

Clinical Differential Diagnosis

Liver – acute hepatitis (viral, bacterial, toxins), neoplasia, trauma, abscessation
Gall bladder – cholecystitis, mucocele, obstruction (lith, neoplasia, duodenal/pancreatic disease)
Pancreas – pancreatitis, neoplasia

Sampling

None

UA Specific Gravity Range

1.003

Patient Information

Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Status : Complete

Clinical Signs

  • Tachypnea
  • Vomiting

Images

preston_dakota_inflamed_gbmpreston_dakota_inflamed_gbm_right_adrenal_mass_adenoma_likelypreston_dakota_inflamed_gbm_lad_normal

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • ALT (SGPT), High
  • Cholesterol, High
  • GGT High

CBC

  • Neutrophils, High
  • WBC, High

Clinical Signs

  • Tachypnea
  • Vomiting
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