- 9 year old FN Border Terrier
- Diagnosed with diabetes mellitus one month ago, currently unstable with vomiting and diarrhoea
- Previous history of liver problem, diagnosed on bloods, resolved on supportive medication, no previous imaging.
- 9 year old FN Border Terrier
- Diagnosed with diabetes mellitus one month ago, currently unstable with vomiting and diarrhoea
- Previous history of liver problem, diagnosed on bloods, resolved on supportive medication, no previous imaging.
- On scan today there was pancreatitis esp of right limb and ileus of stomach, hepatomegaly and what looked like metabolic hepatopathy.
- My query concerns the gallbladder, it was completely echogenic but did not appear like a typical mucocoele. Is this sludge or a mucocoele or a mass? There was only colour uptake on wall from my impression.
- The common bile duct was normal and tbil was normal.
Comments
Hi! The gallbladder is
Hi! The gallbladder is moderate to severely distended in size with primarily nondependent, nonmineralized, severe debris in the lumen. The debris does not appear to be mobile on the images but is not organized in the classic “kiwi” appearance of a mucocele either. The visible cystic duct area appears normal. The GB walls are thin with normal echogenicity. There are no signs of peri-gallbladder effusion or inflammation. The omentum in the cranial abdomen in echogenic likely secondry to pancreatitis. The visible liver appears reactive. No obvious masses are present.
I would describe this as severe, nondependent, nonmineralized, nonmobile gallbladder debris with potential for immature mucocele (since the debris appears to be immobile). Medical treatment (Ursodiol, continued SAMe) would be recommended at this time without evidence of adjacent effusion, pain when applying pressure to area of gallbladder and normal TBIL. Follow up ultrasonograhic monitoring every few months, obviosly sooner if signs of cholestasis on bloodwork develop, would also be recommended.
Yeh mucoceles can look very
Yeh mucoceles can look very different depending on breed and the kiwi thing is only there in about 50% of th etime in my experience.
keeping on th e fruit and vegetable themes: Pudgy breed dogs like terriers get rounded kiwi or tomatoe mucoceles and German Shepherds get long egg plant looking mucoceles.. and forms in between with the in between breeds. Cats get them secondary to triad disease… a study we are working on.
Check out “mucocele” as key word in the BASIC SEARCH and see the variety of mucoceles out there. There are humndred+ cases ion the archive of all types:
https://sonopath.com/members/case-studies/search?text=mucocele&species=All
So mucocele, atypical mucocele, and emerging mucocele are 3 terms I throw around to categorize and deal with the semantics.
Overdistended Gb with immobile debris and striating bile is a typical mucocele but if you dont have all this then atypical or emerging mucocele would be appropriate.
GB motility study is helpful here from resources to asses the clinical effect if th eGB is actually workign or not.
https://sonopath.com/resources/instructional-library-interventional-procedures-sonopodcasts
I would call this one your posted as an atypical mucocele because not a lot of striation but certainly overdistention and immobile sludge and functionality to be clarified by a GB motility study. Endocrinopathy dogs get mucoceles very readily by the way.
Often when you take these out you find its been causing low grade blahs to the dog and energy comes back.
See our study on the clinical presentations of suirgical biliary disease as well as this may turn surgical and if its my dog I’m likely just removing it anyway especially since the cbd is clean and its an easy cholcystectomy now without inflammation. But I am very proactive on these as well. But I think if you go through the archive link on mucoceles above… all 150 of them or so you likely will come to the same conclusion:)
See Defining a Gb mucocele article and the Surgical parameters abstract from ECVIM Porto 2009 that we did. Should clear things up pretty well.
https://sonopath.com/resources/research-publications
Nice post and thread guys!
Thankyou both for your really
Thankyou both for your really helpful comments.