Case Study

Neutrophilic pancreatitis, post-hepatic obstruction, and portal hepatitis, diagnosed on FNA, in a 12 year old MN Labrador Retriever

This 12-year-old neutered male chocolate Labrador Retriever dog presented for a history of profound lethargy, occasional vomiting and progressive anorexia. The physical exam revealed moderate dehydration and mild cranial abdominal pain. The CBC revealed mild leukocytosis with a left shift. The blood chemistry demonstrated severely elevated amylase and lipase, severely elevated triglycerides, mildly elevated SAP, mildly elevated total bilirubin, mildly elevated cholesterol, mildly elevated sodium, mildly elevated potassium, and mildly elevated phosphorus.

This 12-year-old neutered male chocolate Labrador Retriever dog presented for a history of profound lethargy, occasional vomiting and progressive anorexia. The physical exam revealed moderate dehydration and mild cranial abdominal pain. The CBC revealed mild leukocytosis with a left shift. The blood chemistry demonstrated severely elevated amylase and lipase, severely elevated triglycerides, mildly elevated SAP, mildly elevated total bilirubin, mildly elevated cholesterol, mildly elevated sodium, mildly elevated potassium, and mildly elevated phosphorus.

DX

Neutrophilic pancreatitis and mild chronic portal hepatitis.

Sonographic Differential Diagnosis

Pancreatic necrosis or potential neoplasia with post-hepatic obstruction.

Image Interpretation

A well marginated hypoechoic mass is noted in the region of the right pancreatic limb. The hyperechoic border is suggestive for a granulomatous bed walling off the pathology. The gallbladder is congested with suspended and dependent debris with dilation of the neck. Bilirubin elevation with pancreatic pathology in the right base is supportive of a diagnosis of post-hepatic obstruction due to the pancreatic pathology and likely concurrent cholecystitis.

Outcome

The patient responded to therapy and was discharged after 5 days of hospitalization. The patient was doing well until a similar episode occurred 6 weeks later at which time he was euthanized.

Clinical Differential Diagnosis

Pancreatitis with extra-hepatic obstruction, pancreatic or other neoplasia, biliary obstruction or rupture, gall bladder mucocele, gastroenteritis, toxin exposure.

Sampling

18-gauge US-guided biopsies of the right pancreatic limb and liver revealed neutrophilic pancreatitis and mild, chronic, lymphoplasmacytic and histiocytic portal hepatitis.