Complex cystic liver mass in a jaundiced 15 year old FS DLH

15 year old FS DLH presented for vomiting, anorexia and diarrhea. PE showed painful abdomen and jaundice.  CBC shows a relative neutrophilia. Chem prof shows ALT=819, GGT=11, TBIli=6.5.  Abdominal ultrasound shows a complex, cystic mass in the left liver.  Free anechoic fluid is seen adjacent to the bladder, liver, and liver mass.  The gallbladder is very small and difficult to visualize.  The hepatic veins are prominent.  The portal vein is congested.  Reactive, echogenic fat is seen adjacent to the pancreas and small intestine.

15 year old FS DLH presented for vomiting, anorexia and diarrhea. PE showed painful abdomen and jaundice.  CBC shows a relative neutrophilia. Chem prof shows ALT=819, GGT=11, TBIli=6.5.  Abdominal ultrasound shows a complex, cystic mass in the left liver.  Free anechoic fluid is seen adjacent to the bladder, liver, and liver mass.  The gallbladder is very small and difficult to visualize.  The hepatic veins are prominent.  The portal vein is congested.  Reactive, echogenic fat is seen adjacent to the pancreas and small intestine.  The pancreatic body is hypoechoic with reactive fat but no masses or nodules seen.  The small intestine shows loss of detail although wall layering is maintainted (just fuzzy in some areas).  The stomach shows gastric stasis. My primary differential diagnoses or hepatic carcinoma, biliary carcinoma, and metastatic carcinoma.  I assume that a benign biliary cystic adenoma wouldn’t rupture and behave like this?  Any other thoughts?  Cytology is pending.

Electrocute

4 responses to “Complex cystic liver mass in a jaundiced 15 year old FS DLH”

  1. Would go for acute

    Would go for acute pancreatitis and hepatic neoplasia. A less likley differential would be cholecystitis with leakage into the surrounding liver and pancreatic tissue. 

  2. Thanks Remo.  The cytology is

    Thanks Remo.  The cytology is as folllows:

    “LIVER PARENCHYMA: Moderate suppurative hepatitis/cholangiohepatitis.

    LIVER MASS: Cystic fluid with minimal evidence of prior hemorrhage

    (macrophages with hemosiderin in them).

    Comments: LIVER PARENCHYMA: This could be secondary to gastrointestinal and/or

    pancreatic disease (triaditis), or an ascending or hematogenous

    infection.

    LIVER MASS: This could represent a traumatized biliary cystadenoma or

    a hematoma. Unfortunately there are no biliary type epithelial cells

    to further support a biliary cystadenoma or cells are showing

    prominent atypia to suggest a malignant process. If the mass is

    resectable and there is no obvious metastatic disease, a surgical

    biopsy should be considered.”

     

    Not sure where to go next from here other than exploratory surgery.

  3. Laparotomy ideal but is the

    Laparotomy ideal but is the patient stable enough? Can consider treating with fluids, analgesics, anti-emetics, Ursodiol, and low-fat intestinal diet first.

  4. Thanks Remo.  The patient was

    Thanks Remo.  The patient was alert, active, but anorexic at the time of the scan.  She has been started on antiobitcs, fluids, and anti-emetics.  I will pass on your othe recommendations to the primary vet.

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