- 14 year old mn Lab presented for progressive anorexia and acute onset lethargy
- HR=90, T=100 F, RR=40, abdominal pain noted
- CBC and chem prof wnl except for increased BUN=37
- Abdominal US showed small pockets of free anechoic fluid near the bladder and between the liver lobes, echogenic reactive fat near the gallbladder neck, extrahepatic biliary tract, and between the liver and stomach
- FNA of the effusion was attempted but yielded only blood suggestive of contamination
- 14 year old mn Lab presented for progressive anorexia and acute onset lethargy
- HR=90, T=100 F, RR=40, abdominal pain noted
- CBC and chem prof wnl except for increased BUN=37
- Abdominal US showed small pockets of free anechoic fluid near the bladder and between the liver lobes, echogenic reactive fat near the gallbladder neck, extrahepatic biliary tract, and between the liver and stomach
- FNA of the effusion was attempted but yielded only blood suggestive of contamination
- Primary differential diagnoses included pancreatitis, lymphatic obstruction (neoplasia), and coagulopathy
- Patient was referred to E-clinic where thoracic imaging revealed pericardial effusion and possible heart base mass, clotting times were normal.
- I did not put the probe on the chest because the HR was normal and the hepatic veins were not dilated :(.
- Is all of this echogenic fat seen adjacent to the liver due to increased caval pressure? It seems quite odd.
