Case Study

03_00213 Snowball L Hepatocellular carcinoma

A 13-year-old FS Samoyed with history of azotemia and urinary leaking, on DES and NF diet, was presented for polyuria. Leukocyturia was present on urinalysis. Abnormalities on CBC and blood chemistry were thrombocytosis, monocytosis, elevated AST, ALT and ALP activity, hyperkalemia, and hyperamylasemia.

A 13-year-old FS Samoyed with history of azotemia and urinary leaking, on DES and NF diet, was presented for polyuria. Leukocyturia was present on urinalysis. Abnormalities on CBC and blood chemistry were thrombocytosis, monocytosis, elevated AST, ALT and ALP activity, hyperkalemia, and hyperamylasemia.

DX

Hepatocellular carcinoma.

Sonographic Differential Diagnosis

Left liver mass. The mass does impinge upon the diaphragm. Therefore, clean resection may not be possible. However an attempt at a left lobectomy in this patient may provide for long term survival.

Image Interpretation

The liver presented a 7.5 x 7.0 cm, deep left sided liver mass that was hyperechoic and impinging on the diaphragm. This may be resectable with complete left lobe lobectomy.

Outcome

Blood pressure measurements were within normal limits. After a normal coagulation panel, the patient underwent ultrasound-guided biopsy of the liver mass. The patient was treated with Denamarin pending histopathology results. The patient was sent for surgical consultation and it was determined that surgery was not a good option. At follow-up examination the patient was found to be doing well and stable on current treatment with Denamarin.