Case Study

03_00229 Sophie L Hepatocellular glycogen accumulation

A 13-year-old SF Chihuahua with a history of hypercalcemia in a wellness profile was presented for evaluation. The rest of the profile and CBC were all within normal limits. Additional history was that the owner reports that although the dog is acting fine she is getting older; and that she has asymptomatic Cushing’s disease. On previous radiographs, renoliths and possibly a pit in the stomach had been present.

A 13-year-old SF Chihuahua with a history of hypercalcemia in a wellness profile was presented for evaluation. The rest of the profile and CBC were all within normal limits. Additional history was that the owner reports that although the dog is acting fine she is getting older; and that she has asymptomatic Cushing’s disease. On previous radiographs, renoliths and possibly a pit in the stomach had been present.

Sonographic Differential Diagnosis

Nodular hyperplasia of the liver with likely inflammatory component and minor potential for neoplasia. Excessive gallbladder debris with aspects of emerging gallbladder mucocele.

Image Interpretation

The liver was swollen in contour with heterogenous, nodular changes and hypoechoic nodules. The largest of which measured 1.24 cm in the deep left liver. The curvilinear contour was not disrupted. This is most consistent with nodular hyperplasia with likely inflammatory hepatopathy. The gallbladder presented a minor amount of excessive debris and distension. Ursodiol therapy would be recommended longterm.

DX

Mild to moderate hepatocellular glycogen accumulation and mixed inflammation.

Outcome

Urine culture and sensitivity, gastrointestinal protectants, dietary change and broad spectrum antibiotics for inflammatory hepatopathy would likely be necessary in this patient. FNA would be warranted. Ursodiol therapy and nutraceuticals would be warranted over the next 8 weeks with reassessment of the liver. Baytril and Metronidazole combination for the liver would be recommended for the next 3 weeks.

Clinical Differential Diagnosis

Hypercalcemia: lab error, neoplasia (lymphoma, anal sac, intestinal, spleen), granuloma, hyperparathyroidism, vitamin D toxicity

Sampling

Cytologies of the liver revealed mild to moderate hepatocellular glycogen accumulation and mixed inflammation.