A 5-year-old MN DSH with history of untreated diabetes mellitus, was presented on emergency for collapse. Physical examination findings were weight loss, pale pink mucous membranes, normal heart and lungs sounds, 5% dehydrated, and a palpable cranial abdominal mass. Abnormalities on CBC and blood chemistry were leukocytosis, neutrophilia, anemia, marked hyperglycemia, elevated ALT activity and elevated BUN, and hyperbilirubinemia. FELV/FIV test was negative. The patient was treated with I.V. fluids, Ampicillin, Metronidazole, and Lantus insulin. Blood glucose 12 hours later was 383 mg/dl.
A 5-year-old MN DSH with history of untreated diabetes mellitus, was presented on emergency for collapse. Physical examination findings were weight loss, pale pink mucous membranes, normal heart and lungs sounds, 5% dehydrated, and a palpable cranial abdominal mass. Abnormalities on CBC and blood chemistry were leukocytosis, neutrophilia, anemia, marked hyperglycemia, elevated ALT activity and elevated BUN, and hyperbilirubinemia. FELV/FIV test was negative. The patient was treated with I.V. fluids, Ampicillin, Metronidazole, and Lantus insulin. Blood glucose 12 hours later was 383 mg/dl.
Case Study
03_00201 Ozzie L Hepatic lipidosis
DX
Sonographic Differential Diagnosis
Probable hepatic lipidosis with suppurative hepatitis. Granulomatous and mineralizing mass in the area of the left pancreatic base. Rule out pancreatic carcinoma vs. chronic inflammation and dystrophic mineralization.
Image Interpretation
The hepatic parenchyma was uniformly hyperechoic. However, hepatomegaly was seen without disruption of architecture. No masses were noted. Diffuse hyperechoic parenchyma is noted when comparing to falciform fat. A 2.5 cm, mixed hypoechoic granuloma or mass mineralizing at the left pancreatic base was present positioned cranial to the left kidney in the video. This actually resembles a kidney in itself but the mass was contiguous with recognizable pancreatic structures such as the pancreatic duct and capsule and the left kidney was identifiable.
Outcome
Although the pancreatic lesion did not appear resectable, a surgical approach was suggested in order to remove and further analyze the mass. The patient was discharged a day later with Lantus, a low residue diet, Clavamox, and Metronidazole. Recheck appointment several days later found the patient BAR with fleas. The patient was treated with Capstar and recommended for a follow-up examination in 6 weeks.
Comments
No further update provided.
Clinical Differential Diagnosis
Diabetes mellitus. Liver disease – diabetic hepatopathy, lipidosis, cholangio-hepatitis complex, neoplasia, infectious, toxic Mass – liver/spleen/pancreas/GI tract/lymph node neoplasia, granuloma, abscess Hydronephrosis
Sampling
FNA of the pancreatic mass revealed possible neutrophilic inflammation and the liver sample revealed hepatocellular vacuolation, suggestive of hepatic lipidosis.
Video
Patient Information
Clinical Signs
- Collapse
History
- Diabetes, uncontrolled
Exam Finding
- Dehydration
- Pale Mucous Membranes
- Palpable mass
- Weight loss
Images
Blood Chemistry
- ALT (SGPT), High
- Glucose, High
- Total Bilirubin, High
CBC
- Neutrophils, High
- RBC, Low
- WBC, High
Clinical Signs
- Collapse