Case Study

Hyperplastic cholecystitis in a 9 year old FS DLH cat

A 9-year-old SF DLH cat was presented for lethargy, vomiting and inappetence. The physical exam revealed an elevated temperature of 103.70F, profound lethargy, and vomiting of green and yellow bile. A CBC revealed mild leukocytosis (14.75 x 109/L) with a left shift. The serum biochemical profile revealed a mild hyperglycemia at 183. Urinalysis revealed 2+ blood, but was otherwise normal.

A 9-year-old SF DLH cat was presented for lethargy, vomiting and inappetence. The physical exam revealed an elevated temperature of 103.70F, profound lethargy, and vomiting of green and yellow bile. A CBC revealed mild leukocytosis (14.75 x 109/L) with a left shift. The serum biochemical profile revealed a mild hyperglycemia at 183. Urinalysis revealed 2+ blood, but was otherwise normal.

Sonographic Differential Diagnosis

Cholangiohepatitis, aspects of emerging GB mucocele, potentially infectious in origin given the fever.

Image Interpretation

The liver parenchyma is mildly coarse and echogenic indicating likely a chronic inflammatory process. The gall bladder is dilated with suspended and largely immobile debris. The wall is slightly thickened. the patient was reported to be painful upon imaging the GB (+ Murphy sign).

DX

Moderate to severe chronic and hyperplastic cholecystitis.

Outcome

The cat made full recovery and appetite and activity level returned to normal.

Clinical Differential Diagnosis

Cholangitis/cholangiohepatitis , pancreatitis with secondary cholestasis and/or cholangiohepatitis, Triaditis with an ascending bacterial infection, pyelonephritis, neoplasia (primary vs. metastatic; lymphoma, adenocarcinoma, leiomyoma, leiomyosarcoma, mast cell tumor,) feline infectious peritonitis, toxoplasmosis, apathetic form of hyperthyroidism

Sampling

A cholecystectomy was performed. The histopathology was consistent with a moderate amount of chronic inflammatory infiltrates consisting of macrophages, lymphocytes, plasma cells and neutrophils involving the mucosa, the muscular wall and the bile duct.