An 8-year-old neutered male Bassett Hound dog was presented for evaluation of icterus with a history of swelling of the left pinna 2 weeks prior. Serum biochemistry showed severely elevated ALP, ALT, and AST activity.
An 8-year-old neutered male Bassett Hound dog was presented for evaluation of icterus with a history of swelling of the left pinna 2 weeks prior. Serum biochemistry showed severely elevated ALP, ALT, and AST activity.
Common bile duct mass at the duodenal papilla. Differentials include bile duct carcinoma, duodenal lymphoma or inflammatory polyp, less likely. Heterogeneous hepatic nodules are suggestive for metastatic disease. Post hepatic obstruction was also present. Strongly suggestive for bile duct carcinoma.
The liver was heterogeneous with heterogenous, target type, hepatic nodules noted. The gallbladder was severely dilated at 9 x 4 cm with common bile duct dilation at 1.73 cm. A 1.1 cm focal, mixed echogenic nodule was noted at the termination of the common bile duct at the duodenal papilla. A separate view of the common bile duct revealed a mineralizing mass that measured 2.75 x 2.12 cm. This is suggestive for bile duct carcinoma or other form of carcinoma. A hepatic lymph node was enlarged which is suggestive for metastatic disease or regional lymphadenitis. Hyperechoic surrounding fat was noted.
None
Liver disease – acute hepatitis (viral, bacterial, toxins, drug-induced), neoplasia. Pancreatic disease – acute pancreatitis. Gall bladder disease – obstruction (neoplasia, lith, duodenal/pancreatic disease), cholecystitis, mucocele.
If the sonographer can obtain fine needle aspirates of the common bile duct mass as well as the liver this would be optimal. Otherwise, fine needle aspirates of the liver nodules would be recommended to assess for metastatic disease. If by chance these nodules are benign, then exploratory surgery with expectations towards bile duct reconstruction and cholecystectomy would be recommended.
