Case Study

Chronic cholecystitis and mucocele formation in a 10 year old MN Chihuahua

A 10-year-old MN Chihuahua with a history of diabetes and severe pancreatitis was presented for evaluation of PU/PD. Urinalysis showed glycosuria and proteinuria with a normal specific gravity (1.039). Abnormalities on serum biochemistry were elevated cholesterol (1257), triglycerides (2485), PSL (229), ALT (360), ALP (5307), GGT (28), BUN (36), and glucose (275).

DX

Chronic cholecystitis and mucocele formation. Enlarged adrenal glands.

Image Interpretation

The liver images from right and left intercostal as well as subcostal views revealed subjectively normal liversize, contour, and structure. Parenchymal echogenicity was naturally coarse and hypoechoic to the spleen. Vascular and biliary tracts were of normal volume and no evidence of congestion was noted. The gallbladder presented a thickened wall and echogenic debris with a pericapsular inflammatory pattern with many aspects of mucocele formation. Striating bile and over distension was noted. Chronic cholecystitis is likely. The common bile duct did not appear to be involved.

The left adrenal gland was similar to the prior sonogram and measured 2.02 x 0.9 cm at the caudal pole and 0.64 cm at the cranial pole. The caudal pole of the left adrenal gland was swollen. The right adrenal gland was also enlarged, hypoechoic and mildly swollen.

Outcome

The interesting issue with the gallbladder is that the echogenic debris within the lumen could not be clearly separated from the apical wall of the gallbladder. There is a minor potential that this is a tissue proliferation or possible tumor within the gallbladder itself. Power Doppler assessment could be considered. Cholecystectomy is recommended regardless in this patient. There was no other evidence of potential neoplasia noted. The PU/PD may be owing to primary Cushing’s disease, PDH. Nutritional changes to address the hypertriglyceridemia would also be warranted. Blood pressure measurements and ACTH stimulation is warranted given the patient’s history if not already performed.