Case Study

Biliary mucosal hyperplasia and gall bladder mucocele in a 8 year old FS Beagle dog

An 8-year-old FS Beagle dog was presented for acute onset vomiting and hemorrhagic diarrhea, following the probable ingestion of garbage one night prior to evaluation. On CBC elevated MCHC, thrombocytosis, and anemia was evident. Blood gases were within normal limits and PCV/TP was 42/9.5. The patient was transferred from the RDVM for continued overnight care at a referral facility. On physical examination hypothermia (98.7 deg F) and a tense and moderately painful abdomen on palpation were present.

An 8-year-old FS Beagle dog was presented for acute onset vomiting and hemorrhagic diarrhea, following the probable ingestion of garbage one night prior to evaluation. On CBC elevated MCHC, thrombocytosis, and anemia was evident. Blood gases were within normal limits and PCV/TP was 42/9.5. The patient was transferred from the RDVM for continued overnight care at a referral facility. On physical examination hypothermia (98.7 deg F) and a tense and moderately painful abdomen on palpation were present. Abnormalities on CBC and blood chemistry were anemia, neutrophilia, elevated ALP and ALT activity, and marked hypercholesterolemia. cPL was 454. PCV/TP was 32/7.0. Blood pressure was within normal range. Survey lateral abdominal radiograph showed decreased abdominal detail, fluid filled intestines but no evidence of obstructive ileus. Survey V/D radiograph showed the upper left quadrant with an area in the small intestines that appeared to abruptly change from gas opacity to fluid/soft tissue opacity. The patient was treated with I.V fluids, analgesics, and anti-diarrheal medication pending an abdominal ultrasound.

DX

Biliary mucosal hyperplasia and mucocele

Sonographic Differential Diagnosis

Nearly mature gall bladder mucocele and inflammatory hepatopathy.

Image Interpretation

The gall bladder is distended with dilated neck and semimobile debris. The neck of the gall bladder is mildly echogenic consistent with inflammation. The near field at 2 o’clock in video 1 shows focally echogenic fat as well suggestive for inflammation rendering the GB likely clinically significant. No free fluid is noted. The visible hepatic parenchyma is coarse suggestive for concurrent chronic inflammatory hepatopathy

Outcome

The patient thrived postoperatively with no complications.

Clinical Differential Diagnosis

GI pathology – acute bacterial/toxin, acute pancreatitis, acute liver disease, intestinal obstruction – foreign body/intussusception, peritonitis.

Sampling

Cholecystectomy was performed successfully after 1 week of failed medical therapy and persistent sonographic presentation. Gall bladder culture not performed. Histopath: Gallbladder: There is diffuse moderate hyperplasia of the gallbladder mucosa with multifocal formation of papillary projections and cystic mucosal glands. Moderate fibrosis and lymphohistiocytic inflammation extend throughout the gallbladder wall and are associated with multifocal regions of hemorrhage. Thick mucinous basophilic globular material fills the gallbladder lumen, dissects between papillary mucosal projections, and fills the submucosal glands. Significant cellular atypia or infectious agents are not observed. 2. Liver: Portal areas are mildly to moderately expanded by lymphocytes, plasma cells, and histiocytes. Histiocytes contain yellow to brown globular cytoplasmic material (interpreted as bile). Multifocal regions of mild biliary hyperplasia are present. Hepatocytes throughout the specimen are mildly to moderately enlarged with microvesicular cytoplasmic change (glycogen accumulation). Multifocal regions of mild to moderate sinusoidal congestion are present.