-
-
- 15 year old mixed breed 10lb dog presented for acute vomiting and anorexia x 3d
- Dx with stage B1-B2 MVdz last November with both left and right side enlargement and low velocity TVI.
- Bloodwork shows WBC=25K with a neutrophilia and monocytosis
- Spec cPL=268 mcg/L, BUN=38mg/dL, TP=5.0g/dL, ALB=2.1g/dL, Na=134mmol/L, Cl=105mmol/L. Liver enzymes and total bilirubin are normal.
- Abd rads showed prev. noted hepatomegaly and possible effusion
- Abd US shows mild hepatomegaly, mild splenomegaly, scan amount of free anechoic fluid adjacent to bladder, caudal spleen and betweent the liver and the diaphragm, thickened ileal muscularis, echogenic right pancreas, and moderate to markedly distended GB with both gravity dependent and suspended faintly echogenic and highly echogenic sludge.
- Echo showed improvement in LA size since last echo but still slightly enlarged. TVI is now at 2.69m/s.
- These images were obtained 30 minutes after feeding to see if the GB would contract…it remained the same size.
- Worried about GB disease …cholecystitis or atypical mucocele or obstruction. Other diff dx for the vomiting and anorexia include pancreatitis, gastroenteritis, and less likely neoplasia.
- Would you cut this GB out?
-
Comments
If the patient was npo for a
If the patient was npo for a bit this can be fairly normal with some excessive sludge and rounded dilation. I would image this 30 min post prandial and see what it looks like. That being said in our study some minor cases of clinical mucoceles have no LE elevations but more common npo induced dilation than true mucocele wihtout LE elevations.
The above posted images were
The above posted images were obtained 30minutes after feeding. The original scan done just prior to feedeing showed similar GB findings. The GB did not decrease in size with feeding. Concerned because I do not know the cause of the scant effusion.
The first video is more
The first video is more convincing of mucocele. if not responding to medical tx then cholecystectomy based on lack of function and mucocele characteritics… its a rarity not having LEs up but does happen because the biliary tract doesnt have much enzyme spillage as that all comes from hepatic parenchyma, brush border cells (SAP) and hepatocytes (ALT/AST). So if just the GB is involved and not the main pipe of the CBD to back everything up hence involving parenchyma, then technically and theoretically LEs dont spill and elevate. The GB is involved as its a resevoir and sort of an island in the liver … a cul de sac connecting to the main line cbd through the cystic duct. That’s the theory anyway why mucocele can be present without LE elevation. Maybe given a little time the SAP will start climbing.