03_00430 Baby B Bile duct neoplasm, EHBDO

Case Study

03_00430 Baby B Bile duct neoplasm, EHBDO

A 15-year-old SF DSH with a history of IBD was presented for evaluation of acute vomiting. Abnormalities on CBC and serum biochemistry were neutrophilia, mild anemia, elevated GGT activity, and hypokalemia.

A 15-year-old SF DSH with a history of IBD was presented for evaluation of acute vomiting. Abnormalities on CBC and serum biochemistry were neutrophilia, mild anemia, elevated GGT activity, and hypokalemia.

DX

Bile duct neoplasm, EHBDO

Sonographic Differential Diagnosis

Post hepatic obstruction.
Tissue density within the common bile duct with calculus or dystrophic mineralization. Strong suspicion for bile duct carcinoma. Possible proliferative tissue and post hepatic obstruction or mucoduct. The gallbladder was severely dilated as well owing to chronic obstruction.

Image Interpretation

The liver in this patient presented a too many tube sign with tortuous cystic duct and common bile duct with excessive dilation. Calculus was noted within the common bile duct with echogenic debris or possible mass measuring 0.95 cm at the junction between the common bile duct and cystic duct. The common bile duct was dilated to the level of the duodenal papilla. The mineralization could represent dystrophic mineralization of bile duct tumor or a separate mass. Lobar biliary ducts were also noted within the liver with hypoechoic nodules. This may represent metastatic disease. A slight amount of free fluid was noted between liver lobes.

Outcome

None

Comments

The bilirubin is not elevated in this patient and occurs on occasion in this insidious progressive, low-grade dilations especially in cats. According to our surgical biliary study in dogs for example, only 35% of surgical biliary disease had elevated bilirubin values. We suspect that this is also the case in cats, yet a current study is underway.

Clinical Differential Diagnosis

Non-specific gastritis – toxins, dietary indiscretion, viral/bacterial infection
Gastric neoplasia
Pancreas – pancreatitis, neoplasia
Gall bladder – cholecystitis, obstruction (pancreatic/duodenal disease, neoplasia, lith)

Sampling

None

Patient Information

Gender : Female, Spayed
Species : Feline
Type of Imaging : Ultrasound
Status : Complete

Clinical Signs

  • Vomiting

Images

baby_burton_feline_bile_duct_massbaby_burton_feline_bile_duct_mass_1baby_burton_feline_bile_duct_mass_2baby_burton_feline_bile_duct_mass_3

Blood Chemistry

  • GGT High
  • Potassium, Low

CBC

  • Neutrophils, High
  • RBC, Low

Clinical Signs

  • Vomiting
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