A 14-year-old FS DSH presented for routine physical examination with mild jaundice and conserved appetite. The diagnostic workup revealed mild neutrophilic leukocytosis with a left shift; serially moderately elevated SAP, moderately elevated ALT, and moderately elevated cholesterol; and mild to moderate progressive hyperbilirubinemia.
A 14-year-old FS DSH presented for routine physical examination with mild jaundice and conserved appetite. The diagnostic workup revealed mild neutrophilic leukocytosis with a left shift; serially moderately elevated SAP, moderately elevated ALT, and moderately elevated cholesterol; and mild to moderate progressive hyperbilirubinemia.
Case Study
03_00046 Princess W Lymphoplasmacytic cholangiohepatitis, vanishing bile duct syndrome SAVE RESEARCH ONLY
Sonographic Differential Diagnosis
A chronic inflammatory hepatopathy is strongly suspected, with neoplasia considered less likely.
Image Interpretation
Transverse view of the left liver reveals marked generalized heteroechoic, hypoechoic parenchyma with altered linearity to the portal vasculature (small arrow.) Echogenic portal vascular walls and an undulating serosal margin (large arrow) are consistent with fibrosis with contracture. Long-axis view of the gallbladder and deep right liver shows increased gallbladder wall echogenicity, echogenic suspended debris, and heteroechoic, echogenic parenchymal echotexture. These findings are consistent with a chronic inflammatory hepatopathy. Neoplasia is considered unlikely.
DX
Severe, chronic, lymphoplasmacytic cholangiohepatitis and "vanishing bile duct syndrome".
Outcome
The patient was medically managed with success for over a year until lost to follow-up.
Comments
No video is available on this patient.
Clinical Differential Diagnosis
Biliary obstruction, inflammatory hepatopathy, neoplasia, pancreatitis with posthepatic obstruction.
Sampling
18-gauge US-guided biopsy revealed severe, chronic lymphoplasmacytic cholangiohepatitis and vanishing bile duct syndrome.
Patient Information
Gender :
Female, Spayed
Species :
Feline
Type of Imaging : Ultrasound
Clinical Signs
- Icterus
Images
Blood Chemistry
- Alkaline Phosphatase (SAP), High
- ALT (SGPT), High
- Cholesterol, High
- Total Bilirubin, High
CBC
- Left Shift
- Neutrophils, High
- WBC, High
Clinical Signs
- Icterus