Case Study

Suspected Hepatocutaneous Syndrome in a 9yr old MN Beagle

Beagle, MN, 9 years. Progressive foot pad hyperkeratosis, general malaise, increased itching, increased liver enzymes, suspect hepatocutaneous syndrome PE: marked foot pad hyperkeratosis with surrounding erosions, perioral crusting and erosive dermatitis, perianal crusting Medications: MiconaHex+Triz shampoo Albumin 2.6, ALT 365, ALKP 375m white count 16000.

Sonographic Differential Diagnosis

Diffuse nodular liver. Suspect hepatocutaneous syndrome. Small bladder calculus, non shadowing with minor cystitis pattern.
Liver biopsy and bile acid profile would be warranted. Potential, mild chronic active pancreatitis. Full urinary work-up would be warranted.

Image Interpretation

The urinary bladder presented a small, non shadowing calculus that measured 0.3 cm and was non obstructive. A minor amount of sand was noted in the bladder as well. The bladder presented slight micropolypoid changes. Full urinary work-up would be warranted if not already performed.

The liver presented heterogenous parenchymal changes and increased portal markings as well as isoechoic, expansive nodules. Given the hyperkeratosis There is a strong potential for hepatocutaneous syndrome. Bile acid profile and core liver biopsy is recommended.