Case Study

Chronic active pancreatitis in an 11 year old MN Balinese cat

This 11-year-old MN Balinese presented for anorexia, lethargy and jaundice 7 days post Bilroth I surgery for resection of a gastroduodenal granuloma. The physical exam revealed dehydration, and focal cranial abdominal pain. The CBC and blood chemistry analysis revealed moderate leukocytosis with a left shift, moderately elevated total bilirubin and moderately elevated ALT with slightly elevated SAP and slightly elevated cholesterol.

This 11-year-old MN Balinese presented for anorexia, lethargy and jaundice 7 days post Bilroth I surgery for resection of a gastroduodenal granuloma. The physical exam revealed dehydration, and focal cranial abdominal pain. The CBC and blood chemistry analysis revealed moderate leukocytosis with a left shift, moderately elevated total bilirubin and moderately elevated ALT with slightly elevated SAP and slightly elevated cholesterol.

DX

Eosinophilic pyogranulomatous chronic active pancreatitis

Sonographic Differential Diagnosis

Severe pancreatitis and peripancreatic inflammation and moderate, diffuse common bile duct dilation. Common bile duct dilation could be the result of partial obstruction and/or referred inflammation secondary to the pancreatic pathology.

Image Interpretation

Pancreatic enlargement, markedly hypoechoic parenchyma with peripancreatic increased echogenicity (Image 1). Color flow Doppler reveals normal blood flow within the portal vein and adjacent portal hilar vascular structures (Image 2). Note suboptimal resolution of the common bile duct due to attenuation by the overlying, inflamed soft tissues. The post treatment images shows moderate resolution of the pancreatic and peripancreatic inflammation (Image 3 & 4). Tortuous CBD (Video 1). Moderate cystic and proximal common bile duct distention seen to the left of the Doppler color flow (Video 2).

Outcome

The bilirubin and ALT values diminished to slightly above normal after 5 days of medical treatment without the use of steroids and pain was not evident when imaging the pancreas at a follow-up exam. Persistent elevation of the absolute eosinophilic count was noted.

Clinical Differential Diagnosis

Post operative complications due to intestinal dehiscence, posthepatic obstruction, pancreatitis, GI ulceration, neoplasia (less likely.)

Sampling

Surgical sampling of the pancreas showed eosinophilic pyogranulomatous chronic active pancreatitis. Similar changes were noted in the cytology from the gastroduodenal granuloma.