Case Study

03-00235 CJ R Cystic duct calculi, IBD—NO IMAGES—

An 11-year-old SF Norwegian Forest Cat was presented for anorexia. Previous abdominal ultrasound had shown intestinal thickening. Although a biopsy was recommended, it was not done and the patient appeared to improve despite no therapy. Abnormalities on CBC and serum biochemistry were lymphopenia, mild hyperglycemia, and elevated urea and cholesterol.

An 11-year-old SF Norwegian Forest Cat was presented for anorexia. Previous abdominal ultrasound had shown intestinal thickening. Although a biopsy was recommended, it was not done and the patient appeared to improve despite no therapy. Abnormalities on CBC and serum biochemistry were lymphopenia, mild hyperglycemia, and elevated urea and cholesterol.

Sonographic Differential Diagnosis

Cystic duct calculi. It is likely that the cystic duct calculi in this patient are causing the clinical signs. Recommend cholecystotomy with common bile duct lavage and removal of the calculi. Upper gastrointestinal, hepatic and potential pancreatic biopsies. The calculi appeared to be too large to pass on their own. Ursodiol can be considered. However, this will not help this patient in the acute state, only long term. Dissolution may be achieved. This is considered a precarious situation given the position and size of the cystic duct calculi.

Image Interpretation

Exam of the cranial abdomen demonstrated largely normal liver size, contour, and structure. Some age-related parenchymal remodeling was noted but likely not clinically significant at this time. Occasional, hyperechoic nodular changes were noted. This is consistent with benign nodular hyperplasia or possible cystadenoma. Vascular and biliary tracts were of normal volume and no evidence of congestion was noted. The gallbladder was slightly dilated and measured 0.87 x 0.27 cm. Some cystic calculi were noted in the base of the cystic duct and in the common bile duct and measured 0.66 cm. This may be causing anorexia. The common bile duct appeared normal at 0.11 cm. The calculi appeared to be embedded, which is likely causing pain. The periportal lymph nodes were not overtly visible and assumed to be normal.

DX

Cystic duct calculi

Outcome

The patient is being monitored for changes.

Clinical Differential Diagnosis

GI tract – IBD, gastric/duodenal ulcer, neoplasia, lymphoma, partial obstruction Pancreas – pancreatitis, neoplasia

Sampling

None

Patient Information

Gender : Female, Spayed

Species : Feline

Type of Imaging : Ultrasound

Clinical Signs

Anorexia

Blood Chemistry

BUN high
Cholesterol, High
Glucose, High

CBC

WBC, Low

Clinical Signs

Anorexia