10 yr FS heeler cross, 1 week anorexia, severe lethargy, acute onset hemorrhagic diarrhea, abdominal pain. Blood work – marked elevated liver enzymes (ALT 800’s, ALP 600’s, T bili normal), mild azotemia. Unfortunately owner declined further workup (no FNA’s). Wondering top rule outs for the hyperechoic infiltrative lesions. This looks like a mucocele getting ready to rupture to me, but want to be sure I’m not over interpreting.
10 yr FS heeler cross, 1 week anorexia, severe lethargy, acute onset hemorrhagic diarrhea, abdominal pain. Blood work – marked elevated liver enzymes (ALT 800’s, ALP 600’s, T bili normal), mild azotemia. Unfortunately owner declined further workup (no FNA’s). Wondering top rule outs for the hyperechoic infiltrative lesions. This looks like a mucocele getting ready to rupture to me, but want to be sure I’m not over interpreting.
Comments
Your still picture has the
Your still picture has the “Kiwi” appearance of a biliary mucocele.
I am thinking this is a mucocele. The cines were not quite as convincing.
Thoughts on the hyperechoic
Thoughts on the hyperechoic infiltrates? They just seemed to be everywhere. As far as mucocele on the video, what criteria would you be looking for? Thank you!
The liver echogenity and
The liver echogenity and texture looks very abnormal- almost like a cholangio-hepatitis. Not sure about all the infiltrates.
I will post a screen shot from Dr Lindquist video on surgical biliary disease and the criteria used to judge if it is a surgical gallblader. They don’t all look clasical like a Kiwi. Missing from the screen shot would be if there is a + murphy sign in the region of the gallbladder.
Maybe someone else can give us their 2 cents.
Thanks randy yes this is
Thanks randy yes this is starting to look like mucocele… certainly double layered wall and overdistention with strating bile… rgeradless what you call it its worth a gb motility study +/- removal. Regarding the mineralizations spleen and liver check cushings as this is the sonographers calcinosis cutis:) You will see this in cushings patients often and cushingoid patients get mucoceles so I would chase the adrenals and clinical endocrinopathy.
Randy, Totally agree with
Randy, Totally agree with Eric. Signs are very siuggestive of Cushing’s disease. You will see similar mineralizations that present themselves as focal hyperechoic points in the cortex of both kidneys. Pancreas will be prominent and the cortial layering of the adrenals may be much more prominent or thickened. We are doing a histological analysis of adrenal glands from HAC dogs to see if this corresponds to hypertrophy or activation of the SER in the cells associated with HAC. News to come later on.
Thanks for the information.
Thanks for the information. Would you see the same changes in the liver as well?
The changesseen in both the
The changesseen in both the spleen and kidneys are not seen in the liver. What you see in an HAC case is the parenchyma being hyperechoic to the falciform fat. What you often image are regenerative nodules because of the increased contrast in a hyperechoic liver. These may be more obvious in older dogs asthey become more common as the dog ages. These are normal nodules, they just become visible once again because of the increased contrast.
Thanks
Thanks
I agree with Bob… spleen
I agree with Bob… spleen for sure, kidneys often… I have seen it in the liver but rarely it may be there underneath the hyperechoic “snow on grass” scenario that these vac hepatopathy nodular hyperplasia endocrinopathy livers present as but the liver mineralization is very rare in apperance in my experience. If I run across one I will post it.
But Ive switched these last coupel of years in thought process when chasing cushings which is one of our usual clincial sonographer tasks… I take the global cushings discussion more seriously when i see the splenic +/- renal cortical mineralization scenario and give more credence to the cushings chase.
Thanks everyone for all of
Thanks everyone for all of your input!