Case Study

Benign vacuolar hepatopathy liver pattern with flattened adrenals in a 7 year old MN Keeshond

A 7-year-old NM Keeshond, with a history of being on long-term prednisone therapy for a chronic sinus problem was presented for evaluation of abdominal distension. Abnormalities on serum biochemistry were severely elevated ALP activity (2000) and mildly elevated ALT and AST activity.

DX

Excessive abdominal fat; Benign vacuolar hepatopathy liver pattern.

Image Interpretation

Both adrenal glands were mildly flattened and subjectively isoechoic to the surrounding fat. The right adrenal gland measured 3.13 x 0.56 cm at the cranial pole and 0.55 cm at the caudal pole. The left adrenal gland measured 2.37 x 0.42 cm at the caudal pole and 0.39 cm at the cranial pole.

The liver revealed a uniform vacuolar hepatopathy pattern. The liver architecture was conserved. The gallbladder was unremarkable with a minimal amount of debris.

A large amount of abdominal fat was noted in this patient. If Prednisone has been utilized in this patient then this would explain the adrenal and hepatic presentation.

Outcome

Flattened adrenal glands, potentially suppressed from exogenous cortisone, Addison’s disease or normal variant. Given the long term use of the prednisone in this patient ACTH stimulation would be warranted to rule out iatrogenic Cushing’s disease.