Case Study

CT – PDH Cushings with bilateral adrenal hyperplasia and steroid induced hepatitis in a 15 year old FS Maltese

This 15 year old FS Maltese has a history of CHF, anorexia, vomting and diarrhea; ultrasound shows fluid filled structure in the liver.

Physical exam: Grade IV heart murmer

This 15 year old FS Maltese has a history of CHF, anorexia, vomting and diarrhea; ultrasound shows fluid filled structure in the liver.

Physical exam: Grade IV heart murmer

DX

The computed tomographic findings support a (pituitary dependend) Cushing’s with bilateral adrenal hyperplasia, steroid induced hepatitis. Moreover multiple liver cysts and nodules are seen and likely compatible with benign nodular hyperplasia and uncomplicated liver cysts. There is no evidence of a macroscopic neoplastic mass lesion. The changes of the pancreas are suggestive for multifocal benign nodular hyperplasia. Chronic pancreatitis is a potential too. The renal changes are indicative of chronic nephritis and a polyuric state which may either be an expression of the primary renal disease or Cushing’s. The cardiac changes are consistent with the history of congestive heart failure.

Image Interpretation

CT of the abdomen and thorax –

The liver presents moderate generalized enlargement with lobar swelling, irreular lobar contours, non-uniform contrast enhancement, multifocal nodular changes and multifocal cysts of up to 1.5 cm diameter. The pancreas presents mild generalized enlargement with undulating contours, mutifocal nodular changes and non-uniform contrast enhancement. Both adrenal glands reveal moderate symmetric enlargement and parenchymal modeling. Both kidneys are relatively small and present undulating contours, multiple cortical cysts and non-uniform contrast ehnancement with an incomplete nephrogram. Left atrial enlargement and pulmonary venous hypertension is noted as well as thicekning of the left ventricular wall.