Case Study

Hepatic abscess with icterus in a 14 year old MN DSH cat

A 14-year-old MN DSH cat presented for mild visible jaundice that was confirmed during the physical examination, which also revealed a poor hair coat and mild dehydration. Preliminary laboratory data revealed moderately elevated ALT and moderately elevated bilirubin levels and mildly elevated SAP and mildly elevated AST.

A 14-year-old MN DSH cat presented for mild visible jaundice that was confirmed during the physical examination, which also revealed a poor hair coat and mild dehydration. Preliminary laboratory data revealed moderately elevated ALT and moderately elevated bilirubin levels and mildly elevated SAP and mildly elevated AST.

DX

Hepatic abscess with suppurative inflammation and necrosis.

Sonographic Differential Diagnosis

These findings are consistent with a hepatic abscess because the thick wall is typical of a granulation bed. A necrotizing or abscessing neoplasia also could be considered. Hepatic abscess with suppurative inflammation and necrosis.

Image Interpretation

A large, well-encapsulated, centrally cavitated mass is seen. The encapsulating wall is thick with a slightly irregular border (small arrows). The encapsulated fluid is moderately echogenic, and distal enhancement is not seen. After drainage, long-axis view of the hepatic abscess shows that wall thickness and border irregularity are exaggerated (arrow) after the distension has been relieved by drainage.

Outcome

This patient repeatedly responded well to supportive antibiotics and periodic drainage with abscess injection of enrofloxacin after drainage.

Comments

This is considered a salvage procedure because the owner refused surgical resection, which would be curative and the treatment of choice.

Clinical Differential Diagnosis

Liver pathology: Hepatitis, biliary obstruction, neoplasia, hepatic abscess; Pancreatic pathology: pancreatitis.

Sampling

An 18-gauge IV catheter in the 1 o’clock position was used to drain the infected cyst/abscess. Fluid analysis demonstrated suppurative inflammation and necrosis with negative aerobic and anaerobic cultures. Antibiotics had been given prior to the procedure. An IV catheter was used to avoid the risk of laceration of the abscess wall by drawing back the stylet into the Teflon catheter after penetration. This technique limits sharp needle tip exposure to the abscess wall as the abscess is emptied. The 18-gauge size was necessary because of the thickness of the fluid.