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- 12yr old miniature schnauzer presented to primary dr. day before this scan for 24-48 hours of marked lethargy. Dog was painful on abdominal palpation. Increased resp effort however heart and lungs sound normal.
- CBC is wnl except for a mild reticulocytosis of 124.1 K/mcL, mild lymphompenia of 0.94K/mcL, and increased MPV of 16.8 fL. Platelet machine count was 124K/mcL however platelet clumping was seen on slide review. WBC= 7.55K/mcL, RBC=5.94 M/mcL, HCT=42.8%. CHEM generally unremarkable except for K=3.4mmol/L. 4DX was wnl.
- The dog was tx with 2mg dexamethazone and fluid therapy last night with Bupreniorphine.075mg IV. Today the dog is BAR and acting normal.
- Abdominal US shows a midsplenic mass, hypoechoic and anechoic subcapsular splenic parenchyma, and gallbladder halo sign with a small gravity-dependent intraluminal sludge ball. A very small amount of free anechoic fluid is present cranioventral to the right kidney. No extrahepatic biliary obstruction is seen. No overt pericholecystic inflammation is seen either. The pancreas and adrenals appear normal.
- US guided FNA performed on the spleen and read out by a cytologist shows benign tissue with mild reactivity and extramedullary hematopoiesis.
- Primary rule outs for the gallbladder halo sign include anaphylaxis, mast cell tumor degranulation, and less likely pancreatitis, cholecystitis, or right sided heart failure/pericardial effusion.
- Rule outs for the small amount of effusion include hemorrhage, coagulopathy, vasculitis, infection, inflammation, thoracic mass, RCHF
- Chest radiographs and echocardiography have been recommended.
- Any other thoughts for what triggered the episode in this dog and why he has gallbladder halo sign? Would you do a splenectomy if nothing is found on CXR or echocardiography? Also, how long does it take for gallbladder halo sign to resolve if due to anaphylactic reaction?
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Comments
Hmmm… that first video is
Hmmm… that first video is not from this patient and I am unable to delete it. So please diisregard it. The 2nd two videos show the GB halo sign with no other obvious pathology.
Hi Melissa! Video of spleen
Hi Melissa! Video of spleen was removed.
I can tell you that my own
I can tell you that my own dog developed a GB with halo sign from a heart mass (chemodectoma) in her right auricle; she had significant pericardial effusion at the time.
Sorry to hear that. I will
Sorry to hear that. I will continue to try to push see if I can get them to let me scan the heart. Because of the splenic mass, I was thinking possible MCT degranulation, but the splenic FNA cytoology does not support that.
Spleen may be an infarct or
Spleen may be an infarct or infiltrative disease siuppressed by the dexameth injection. Immune mediated gb edema is my guess. I would full coag and then splenectiomy and bx. bx live as well and maybe centsesis of the gb and culture
Gallbladder was really not
Gallbladder was really not that exciting except for the halo sign. Would like to see the chest before recommending splenectomy, especially since cytology was benign. Tried to post the spleen video but it did not go through correctly. I like the idea of a coag panel and did recommend that. We’ll see what happens. What immune mediated diseases cause gb edema? This dog was not anemic nor thrombocytopenic at the time of initial presentation and no hx of trauma.
yes any sort of anaphylaxis
yes any sort of anaphylaxis would cause Gb edema. I’ve seen it wiht vaccine reactions for example.