Case Study

03_00175 Pumpkin E Hepatic lipidosis

A 5-year-old FS DSH was presented for anorexia, lethargy, and not himself. The only abnormality on physical examination was icterus. The patient was treated with I.V. fluids with dextrose, Denamarin, Baytril, metronidazole, and syringe feeding. 48 hours later bilirubinuria was noted on urinalysis.

A 5-year-old FS DSH was presented for anorexia, lethargy, and not himself. The only abnormality on physical examination was icterus. The patient was treated with I.V. fluids with dextrose, Denamarin, Baytril, metronidazole, and syringe feeding. 48 hours later bilirubinuria was noted on urinalysis.

Sonographic Differential Diagnosis

Probable hepatic lipidosis, possible underlying infiltrative neoplasia of the liver. Inflammatory hepatopathy also possible.

Image Interpretation

The liver was swollen in contour and diffusely hyperechoic in this patient. This is consistent with hepatic lipidosis or potential emerging lymphoma or other neoplastic event. 25-gauge fine-needle aspirates were performed and submitted for cytology review. The gallbladder was mildly thickened. The common bile duct was normal. No periportal lymphadenopathy was noted.

DX

Hepatic lipidosis

Outcome

Cytology review of a blood smear with potential cytology assessment of the bone marrow was recommended. Primary liver therapy and empirical prednisolone was suggested due to the concern of hemolytic disease. The patient was treated with Zithromax, to which there was a slow improvement in the icterus and hydration. The patient was discharged with Denamarin, Baytril, metronidazole, taurine, and L/D diet for continued syringe feeding at home. A few days later an esophagostomy tube was placed to facilitate nutritional support.

Comments

No video is available on this patient.

Clinical Differential Diagnosis

Hemolytic disease – IMHA, hemoplasmosis, toxins. Liver disease – cholangio – cholangiohepatitis complex, lipidosis, infections, toxins. Post hepatic obstruction – bile duct obstruction, pancreatic disease, duodenal obstruction.