Skip to content
Customize Consent Preferences

We use cookies to help you navigate efficiently and perform certain functions. You will find detailed information about all cookies under each consent category below.

The cookies that are categorized as "Necessary" are stored on your browser as they are essential for enabling the basic functionalities of the site. ... 

Always Active

Necessary cookies are required to enable the basic features of this site, such as providing secure log-in or adjusting your consent preferences. These cookies do not store any personally identifiable data.

No cookies to display.

Functional cookies help perform certain functionalities like sharing the content of the website on social media platforms, collecting feedback, and other third-party features.

No cookies to display.

Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics such as the number of visitors, bounce rate, traffic source, etc.

No cookies to display.

Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.

No cookies to display.

Advertisement cookies are used to provide visitors with customized advertisements based on the pages you visited previously and to analyze the effectiveness of the ad campaigns.

No cookies to display.

Duodenal mass with post hepatic obstruction in a 7 year old FS SharPei

Case Study

Duodenal mass with post hepatic obstruction in a 7 year old FS SharPei

A 7-year-old SF Shar Pei was presented for evaluation of vomiting for 2 days, inappetence, and icterus. CBC was within normal limits. Abnormalities on serum biochemistry were elevated ALT (2067) an ALP activity (977), and total bilirubin. Coagulation panel showed prolonged PTT (71).

A 7-year-old SF Shar Pei was presented for evaluation of vomiting for 2 days, inappetence, and icterus. CBC was within normal limits. Abnormalities on serum biochemistry were elevated ALT (2067) an ALP activity (977), and total bilirubin. Coagulation panel showed prolonged PTT (71).

Image Interpretation

The gastroesophageal inlet in this patient was thickened with hypertrophied muscularis. The upper duodenum in this patient revealed focal thickening with loss of mural detail. The wall thickness measured 2 cm occupying extension of approximately 5-7 cm. Regional lymph node also mildly enlarged measuring 1.5 cm. 

Reactive mesentery was noted in the region of the pancreas.

The liver was hypoechoic, mildly irregular. This may be normal for this patient; however, given the bilirubin elevation, early infiltrative disease could not be ruled out. Ultrasound guided FNA was performed without complication. The gallbladder was unremarkable. The cystic duct and common bile duct were mildly dilated the upper limits of normal 0.5 cm. Likely some level of posthepatic obstruction owing to the duodenal pathology. The common bile duct was followed to the level of the duodenal papilla where persistent 0.5-0.8 cm dilation was noted with posthepatic obstruction from the duodenum.

DX

Duodenal mass with posthepatic obstruction. Possible early infiltrative disease within the liver.

Outcome

Recommend assessment of the FNA of the intestinal mass and liver to assess for micrometastasis in the liver. The hope is that Chemoreduction would be warranted. This is a difficult area to perform resection anastomosis given the pancreatic presentation. Chemoreduction would likely be the best option in this patient if this is round cell neoplasia. Differentials include round cell neoplasia such as lymphoma versus carcinoma.

Clinical Differential Diagnosis

Liver – acute hepatitis (viral, bacterial, toxins), infiltrative neoplasia (lymphoma, mast cell, histiocytosis)
Leptospirosis
Gall bladder – cholecystitis, mucocele
Pancreas – pancreatitis, neoplasia, abscessation

Video

Patient Information

Patient Name : Taylor Cooper
Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 04_00551

Clinical Signs

  • Anorexia
  • Vomiting

Exam Finding

  • Icterus

Images

new1new5new6new8new9new10

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • ALT (SGPT), High
  • Total Bilirubin, High

Clinical Signs

  • Anorexia
  • Vomiting

Special Testing

  • PTT Prolonged