Case Study

03_00422 Chubaka H Cholecystitis, chronic liver changes, suspect PDH

A 15-year-old NM Multipoo was presented for evaluation of suspected Cushing’s disease based on a low-dose-dexamethasone suppression test. There was a history of PU/PD and polyphagia. On physical examination, alopecia and calcinosis cutis were evident. Abnormalities on serum biochemistry were elevated liver enzyme activity and non-regenerative anemia.

DX

Cholecystitis, chronic liver changes, suspect PDH

Sonographic Differential Diagnosis

Cholecystitis presentation. Bilateral adrenal hypertrophy. Mild chronic hepatic and renal changes. Dystrophic mineralization of the kidneys. PDH suspected. Blood pressure measurements recommended. Cholecystectomy would be ideal. Common bile duct does not appear to be involved. Trilostane therapy should be initiated. Ursodiol therapy may help temporarily; however, the chronic mineralization of the gallbladder wall and the full mucocele formation is not likely going to be responsive to medical therapy alone. Therefore, surgical resection of the gallbladder is strongly recommended with common bile duct lavage.

Image Interpretation

Liver was coarse in architecture, uniform swelling. Focal mineralization noted in variable portions of the liver. Gallbladder presented striated bile, suspended consistent with emerging mucocele. The right intercostal approach of the gallbladder revealed more significant mucocele-type presentation with excessive dilation of the cystic duct and kiwi-type appearance. Right adrenal slightly enlarged, hypoechoic caudal pole 0.82 cm; cranial pole 1.0 cm, 1.85 cm in length. Left adrenal enlarged 1.06 cm with echogenic capsule potentially mineralizing, generalized enlargement noted 2.45 x 0.79 cm cranial; 0.79 cm caudal. Slight irregularity of the cranial pole.
Kidneys presented moderate degenerative changes, cortical cysts and dystrophic mineralization. Right kidney 5.03 cm. Left kidney similar to the right. Cortical mineralization left kidney 4.37 cm. Pelvic mineralization noted in both kidneys.