a 12tr old f/s dachshund presented for surgery to remove cutaneous adenomas that were bleeding. Pre op blwk showed alp 1436,alt,224,ggt8. urine sg 1026. she was scanned and three still images are sent. the adrenals were rounded and 8mm at cdl pole bilaterally, the portal vien velocity is less than 1.This was all incidental findings the dog is normal at home according to owner.acth was done pre 8.2 and post 24.7 (> 22 cushing). My question is I feel this liver looks worse then I would expect with emerging HAC. I have recommended FNA.
a 12tr old f/s dachshund presented for surgery to remove cutaneous adenomas that were bleeding. Pre op blwk showed alp 1436,alt,224,ggt8. urine sg 1026. she was scanned and three still images are sent. the adrenals were rounded and 8mm at cdl pole bilaterally, the portal vien velocity is less than 1.This was all incidental findings the dog is normal at home according to owner.acth was done pre 8.2 and post 24.7 (> 22 cushing). My question is I feel this liver looks worse then I would expect with emerging HAC. I have recommended FNA. I suspect portal hypertension as well. Two problems?
Comments
yes pretty lumpy liver
yes pretty lumpy liver likely a chronic inflammatory hepatopathy on top of the vac hepatopathy you would expect with Cushings but I personally don’t believe typical Cushings til USG is solidly < 1.020 repeatedly. Dachshunds have plump adrenals in general and the breed needs to be defined in this case…. estrogen?? progestersone… thyroid?? none of the above? its still a nebulopathy but likely emerging Cushings with acth stim at post of 24 especially if polyphagic.
Re the liver I suggest bile acids and core Bx as this is a structural issue given the increased portal markings (arrows) and lumpy coarse structure… so for the true dx and not just cells you need a core to assess the portal triads and rule out copper and other issues.
FNA is fine to confirm your garden variety vac hep or rule out lsa, mct and so forth but when curvilinear patterns are disrupted and become irregular like these portal markings (arrow) then core bx is better,
Thanks alot I’llsee if they
Thanks alot I’llsee if they will pursue.I’ll let you know what we find
yes pretty lumpy liver
yes pretty lumpy liver likely a chronic inflammatory hepatopathy on top of the vac hepatopathy you would expect with Cushings but I personally don’t believe typical Cushings til USG is solidly < 1.020 repeatedly. Dachshunds have plump adrenals in general and the breed needs to be defined in this case…. estrogen?? progestersone… thyroid?? none of the above? its still a nebulopathy but likely emerging Cushings with acth stim at post of 24 especially if polyphagic.
Re the liver I suggest bile acids and core Bx as this is a structural issue given the increased portal markings (arrows) and lumpy coarse structure… so for the true dx and not just cells you need a core to assess the portal triads and rule out copper and other issues.
FNA is fine to confirm your garden variety vac hep or rule out lsa, mct and so forth but when curvilinear patterns are disrupted and become irregular like these portal markings (arrow) then core bx is better,
Thanks alot I’llsee if they
Thanks alot I’llsee if they will pursue.I’ll let you know what we find