Case Study

03_00210 Lilly S Hepatic inflammation

A 7-year-old FS Beagle was presented for anorexia and not doing right. Abnormalities on blood chemistry were elevated ALT and elevated AST activity, elevated CK, and elevated triglycerides. CBC a month later was within normal limits but recheck blood chemistry showed ongoing elevated liver enzyme activity.

A 7-year-old FS Beagle was presented for anorexia and not doing right. Abnormalities on blood chemistry were elevated ALT and elevated AST activity, elevated CK, and elevated triglycerides. CBC a month later was within normal limits but recheck blood chemistry showed ongoing elevated liver enzyme activity.

Sonographic Differential Diagnosis

The prominent periportal markings in the liver can occur with cholangiohepatitis or chronic hepatitis but can also be normal for this dog. Inflammatory hepatopathy likely with potential emerging neoplasia such as lymphosarcoma owing to the aggressive clin-path presentation.

Image Interpretation

The liver was homogenous and normal in echogenicity with prominent periportal markings. Mild periportal lymphadenopathy was present suggestive for reactive lymphadenitis given that the lymph nodes maintain structure and architecture but early neoplasia such as lymphoma can also present in this manner. The linear focus in image 3 (arrow) represents a 22ga needle.

DX

Liver: lymphocytic and neutrophilic inflammation.

Outcome

The only abnormality on urinalysis was low specific gravity (1.010). Urine culture yielded no growth. The patient was recommended for treatment of cholangiohepatitis with Clavamox, metronidazole, Actigall, and Denamarin.

Comments

Ideally automated core biopsy would have been performed in this patient for a more definitive diagnosis given that the increased portal markings would suggest structural disease. Financial concerns allowed only for FNA which accomplishes the following 1) largely rules in or rules out cellular neoplasia such as mast cell disease or lymphoma. 2) Defines the prominent cell type to refine the therapeutic protocol.