Case Study

03_00376 Millicent R Microhepatica

A 3-year-old SF Boxer mix was presented for evaluation of acute onset icterus, vomiting, and anorexia. The only abnormality on urinalysis was bilirubinuria. On serum biochemistry severely elevated ALT activity, elevated ALP and GGT 27 activity, total bilirubin cholesterol, PT and PTT, and pre-and postprandial bile acids were present.

Sonographic Differential Diagnosis

Microhepatica and fibrosis pattern. Possible concurrent portal vein hypoplasia. intercostal approach would be necessary for a core biopsy.

Image Interpretation

The liver in this patient was significantly small with significant, heterogenous parenchymal changes. The liver measured 3.5 cm in short axis. Portal vein velocity was subnormal at 18cm/sec. The gallbladder was unremarkable. Decreased portal markings were noted.
The adrenal glands appeared flattened and isoechoic. The left adrenal gland measured 3.62 x 0.27 cm at the cranial pole and 0.5 cm at the caudal pole. ACTH stimulation is recommended. The right adrenal gland measured 0.43 x 3.46 cm.

DX

Microhepatica

Outcome

None

Clinical Differential Diagnosis

Liver – acute hepatitis (viral, bacterial, fungal, toxins, trauma), leptospirosis, lymphoma, chronic-active hepatitis
Acute hemolysis – IMHA, infection (viral, bacterial, protozoal), toxins