Case Study

Chronic post hepatic obstruction, suspect bile duct carcinoma, in a 9 year old FS DLH cat

A 9-year-old FS DLH cat with a history of hepatic lipidosis and icterus was presented for evaluation, as there had been no response to therapy. On physical examination, icterus and weight loss was present. Abnormalities on CBC and serum biochemistry were monocytosis, lymphopenia, elevated SDMA (18) and liver enzyme activity (ALT 453, AST 249, ALP 252, GGT 11), and severely elevated total and conjugated bilirubin (299, and 183 respectively).

DX

Chronic post hepatic obstruction, possible bile duct carcinoma

Sonographic Differential Diagnosis

Chronic post hepatic obstruction. Echogenic common bile duct material; strong potential for bile duct carcinoma. No overt metastatic disease within the liver; however bile duct neoplasia can be isoechoic.
Recommend exploratory surgery in this patient with expectations towards bile duct reconstruction. Coagulation panel is recommended. The isoechoic echogenic structures within the common bile duct could not be differentiated from tumor versus coalesced bile. Bile clot or chronic inflammatory tissue all possible with in the posthepatic biliary tree. Very guarded prognosis.

Image Interpretation

Liver in this patient presented severe gallbladder dilation. The gallbladder measured approximately 3 x 2 cm with significant echogenic debris and double layered wall. Cystic duct, common bile and lobar biliary duct dilation were noted. Common bile duct was dilated to 1.5 cm. Echogenic material was noted in the cystic duct and common bile duct, was isoechoic to surrounding tissue. The presence of lobar duct dilations indicates severe chronic posthepatic obstruction. A separate echogenic structure was noted within the common bile duct measuring 1.37 cm.

Clinical Differential Diagnosis

Hepatic lipidosis, neoplasia, bile duct obstruction (lith, neoplasia, duodenal/pancreatic disease)
Gall bladder – neoplasia, cholecystitis, obstruction
Pancreas – pancreatitis, neoplasia