Case Study

03_00428 Sasha J Mucoduct (is this really a word?) EHBDO

An 11-year-old SF miniature pinscher was presented for evaluation of decreased appetite, weight loss, and vomiting. Abnormalities on serum biochemistry were elevated AST and ALT activity and severely elevated ALP and GGT activity, and total bilirubin.

Sonographic Differential Diagnosis

Mucoduct. Gallbladder mucocele. Duodenal papilla polyp. Potential neoplasia, post hepatic obstruction. Regional, secondary pancreatitis.
Recommend exploratory surgery. If no obvious neoplasia is noted then reconstruction of the common bile duct is recommended. Some echogenic material was noted within the common bile duct. This is also consistent with bile calculi. Guarded prognosis. There is significant friability to the common bile duct and regional tissue should be expected.

Image Interpretation

Minor, heterogeneous hepatic nodular changes were noted which subjectively appear benign. The gallbladder was severely dilated with pericapsular inflammatory pattern at the neck of the gallbladder. This is consistent with mucocele formation. The common bile duct was severely dilated with inspissated debris and measured 1.24 cm. The gallbladder measured 6 x 4 cm. Lobar biliary duct dilation was noted throughout the liver. Suspended, immobile bile was noted throughout the gallbladder. This is most consistent with post hepatic obstruction. Stricture or simple mucoduct is suspected. The duodenal papilla revealed a slight, hyperechoic nodule that measured 1.0 cm. This is potentially owing to bile duct carcinoma or another neoplastic event. However, this appears isolated.

DX

Mucoduct, EHBDO

Outcome

None

Clinical Differential Diagnosis

Gall bladder – cholecystitis, mucocele, obstruction (lith, neoplasia, pancreatic/duodenal disease)
Pancreas – pancreatitis, neoplasia
Liver – neoplasia, cirrhosis, granulomatous disease