Case Study

03_00208 Star P Ferret Inflammatory hepatopathy, reactive lymphadenitis

A 5-year-old FS ferret with prior history of left adrenalectomy was presented for annual examination. Abnormalities on CBC and mammalian chemistry were a low HCT, elevated alkaline phosphatase, low phosphorus, and hypoglycemia. The patient was treated with Lactulose, Milk Thistle, and Nutrived.

A 5-year-old FS ferret with prior history of left adrenalectomy was presented for annual examination. Abnormalities on CBC and mammalian chemistry were a low HCT, elevated alkaline phosphatase, low phosphorus, and hypoglycemia. The patient was treated with Lactulose, Milk Thistle, and Nutrived.

DX

FNAs of the liver were inconclusive. Lymph node aspirate revealed probable reactive lymph node.

Sonographic Differential Diagnosis

This is consistent with inflammatory hepatopathy and minor possibility of infiltrative hepatic disease. Inflammatory bowel disease is a possibility or possible lymphoma.

Image Interpretation

The abdomen in this patient presented a swollen liver with increased portal markings and minor periportal lymphadenopathy. Epigastric lymph node was also enlarged at 1.0 cm with prominent intestinal wall. It was adjacent to periportal lymph nodes that were also enlarged. At 0.6 cm, a hypoechoic structure was also noted in the region of the left adrenal gland presumed to be left adrenal adenoma.

Outcome

The patient was recommended for a recheck sonogram within six months and continued treatment with Milk Thistle and Lactulose. Abnormalities on recheck blood work a month later were elevated total protein, moderately elevated ALT, elevated alkaline phosphatase, hypoglycemia, and elevated chloride. An exploratory surgery would be warranted with biopsies of the epigastric lymph node, liver, and removal of the adrenal gland if necessary.