History:
-Decreased appetite.
-Current meds: Metronidazole, Denamarin, Mirataz.
-Abnormal PE/Chem/CBC/UA Results: ALT 393, TBili 5.7, Mag 2.7, Chol 307, Amyl 1891, PSL 50,
Lymphs 9, Mono 8, Neuts 11,680, Mono 1280,eos 1600, USG 1.048
Case Study
Concern for post hepatic obstruction.
Sonographic Differential Diagnosis
The gastrointestinal presentation revealed mild uniform prominence of the gastric mucosa as well as
areas of “ropey” small intestinal wall with slight disruption of the normal 1:3 muscularis/mucosal ratio.
The intestinal submucosa was slightly irregular, thickened and hyperechoic suggestive of low grade,
chronic disease. The mesenteric lymph nodes were slightly enlarged and reactive.
Comments
Primary concern is for post hepatic obstruction. However, a concurrent hepatic lymphoma cannot be ruled out as the cause of the clinical profile.
The common bile duct appears to taper into the duodenal papilla
adequately. Screening ultrasound-guided FNA of the liver is recommended, to ensure that no obvious
lymphoma is present followed by surgical intervention with cholecystectomy and common bile duct
lavage. Potentially two separate issues are likely playing a role in this patient with the possibility of
hepatic lymphoma. Guarded prognosis.
Clinical Differential Diagnosis
ULTRASONOGRAPHIC FINDINGS
-Hepatic swelling with common bile duct dilation and free fluid.
-Biliary calculi, may be incidental.
-Scalloping spleen.
Patient Information
Gender :
Male, Neutered
Species :
Feline
Type of Imaging : Ultrasound
Status :
Complete
Images
