Case Study

Lymphocytic hepatitis in a 7year old MN Shepherd mix dog

This 7 year old MN Shepherd mix presented with vomiting and lethargy of one week duration. Febrile. ALKP 655, amylase 2164

DX

lymphocytic hepatitis

Sonographic Differential Diagnosis

Hepatic lymphadenopathy.
Inflammatory hepatic changes. Hepatic vein dilation of unknown origin.
Nodule of the right pancreatic base or overlying lymph node. Both present in this
manner. However, lymph node is more likely,

Image Interpretation

The liver was coarse in architecture. Increased portal markings were noted in the liver.
Minor heterogenous cortical parenchymal changes were noted. The liver presented
dilated hepatic veins. This would be normal for a heavily sedated patient, right heart
disease or causes of obstructive caval disease. The thorax should be investigated with
an echocardiogram and chest radiographs. I am not sure how this plays into the
presentation. The gallbladder was mildly thickened with a minor amount of debris. A
hepatic lymph node was enlarged and measured 2.5 x 2.0 cm with regional
inflammation and extended into the pancreas. This is a concerning finding. Ultrasoundguided
FNA would be ideal; however, this may be a difficult region to access given the
vicinity to the portal vein. Ultrasound-guided FNA of the liver may prove diagnostic
with regards to the cause of the lymph node enlargement. The pancreas revealed a hypoechoic region. This is either a nodule of the right
pancreatic base or an overlying lymph node with regional inflammation and was
localized in the right base

Outcome

Abdomen was unremarkable other than the above liver and pancreatic changes. FNA of the liver performed; hepatic lymph node was inaccessible. Treatment for pancreatitis would be
warranted in the meantime. There was no evidence of gastric foreign body. Otherwise,
surgical intervention could be considered. Guarded prognosis.