Case Study

CT – Gastritis and cholecystitis with possible mast cell metastases in a 11 year old MN Terrier mix

This 11 year old MN Terrier mix presented two days ago for anorexia, vomiting and diarrhea. History of seizures, collapsing trachea, cough, grade II mast cell with incomplete resection right inguinal area. Long term pred and tramadol.

PE: mild jaundice, overweight, panting

CBC/Chem: 8/24/16 – bili 4.48, ALKP 4382, ALT 278, AST 801, Chol 519; 8/23/16 – bili 1.22, ALKP 3062, ALT 2816, AST 640

PE: mild jaundice, overweight, panting

CBC/Chem: 8/24/16 – bili 4.48, ALKP 4382, ALT 278, AST 801, Chol 519; 8/23/16 – bili 1.22, ALKP 3062, ALT 2816, AST 640

DX

The findings are consistent with gastritis and cholecystitis with subsequent edema of the gastric and gallbladder-wall

Image Interpretation

CT of the abdomen and thorax –

abdomen:

Gravity dependent mineral attenuating mildly irregular roundish concrement is visible on the ventral gall bladder wall. The wall of the gallbladder presents moderate thickening at 3.5 mm with hypoattenuating layering. The common bile duct presents mild generalized dilation without evidence of mechanical obstruction. The stomach is moderately distended with gravity dependent material (fluid). The gastric wall, especially in the region of the pyloric antrum, is subjectively thickened with reduced rugal-folds. The appearance of the gastric wall is stationary over all acquired scans. The hepatic lymph nodes present mild symmetric enlargement

Outcome

Secondary functional ileus and reactive lymphadenitis
of the tributary hepatic lymph-nodes is present. The history of increasing liver enzymes and the changes of the gallbladder are compatible with hepatitis and concurrent cholecystitis. The cholelithiasis may have an
inflammatory cause, there is no evidence of biliary obstruction.
However, with the history of incomplete removal of a mast-cell tumor, there is a very
unlikely chance of diffuse neoplastic spread of the mast-cell tumor to the gastric wall
and hepatic structures.
For further staging of mast-cell tumor FNA samples of spleen and liver are essential, if
possible the hepatic lymph nodes should be included as well.