03-00243 Kramer V Biliary Mucocele——NO IMAGES—-

Case Study

Case Study

03-00243 Kramer V Biliary Mucocele——NO IMAGES—-

A 13-year-old MN Sheltie had initially been presented at the primary veterinarian for lethargy, anorexia, vomiting, and diarrhea with abnormalities on CBC and serum chemistry being leukocytosis, azotemia, elevated TP, inorganic phosphate, cholesterol, and ALP activity. The pet was subsequently referred to a 24-hour emergency referral hospital were on physical examination discomfort on abdominal palpation was found. Further testing showed pyuria, crystalluria, elevated bilirubin and ALT activity, hemoconcentration, and faint positive for Lyme on ELISA 4DX snap test.

A 13-year-old MN Sheltie had initially been presented at the primary veterinarian for lethargy, anorexia, vomiting, and diarrhea with abnormalities on CBC and serum chemistry being leukocytosis, azotemia, elevated TP, inorganic phosphate, cholesterol, and ALP activity. The pet was subsequently referred to a 24-hour emergency referral hospital were on physical examination discomfort on abdominal palpation was found. Further testing showed pyuria, crystalluria, elevated bilirubin and ALT activity, hemoconcentration, and faint positive for Lyme on ELISA 4DX snap test.

DX

Biliary mucocele

Sonographic Differential Diagnosis

Gallbladder mucocele. The large amount of hyperechoic mesentery all around the neck and base of the gallbladder and the portal hilus in conjunction with pain, elevated liver enzymes and elevated white blood cell count is most consistent with a previously ruptured gallbladder with focal inflammation / peritonitis.

Image Interpretation

The gall bladder was distended and full of sludge in a stellate (kiwi) pattern consistent with a fully developed mucocele. There was a large amount of hyperechoic mesentery noted at the neck of the gallbladder as well as along the portal hilus concerning for focal peritonitis and inflammatory adhesions secondary to rupture.

Outcome

The owner elected to humanely euthanasia the pet.

Clinical Differential Diagnosis

Kidney – chronic kidney disease, pyelonephritis, renoliths, abscess, neoplasia Liver – neoplasia, hepatitis (viral, bacterial, fungal), toxins, drug-induced Gall bladder – cholecystitis, obstruction, rupture Peritonitis – from intestinal/urinary/gall bladder disease

Sampling

None

Patient Information

Gender : Male, Neutered
Species : Canine
Type of Imaging : Ultrasound

Clinical Signs

  • Anorexia
  • Diarrhea
  • Lethargy
  • Vomiting

Exam Finding

  • Abdominal Pain

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • ALT (SGPT), High
  • Azotemia
  • Cholesterol, High
  • Phosphorus, High
  • Total Bilirubin, High
  • Total Protein, High

CBC

  • Hematocrit, High
  • WBC, High

Clinical Signs

  • Anorexia
  • Diarrhea
  • Lethargy
  • Vomiting

Special Testing

  • Lyme Positive

Urinalysi

  • Bacteria Present
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