Hi all,
Hi all,
I got this case of a 12yo FS poodle with ruptured gallbladder, localized peritonitis, abdominal free fluid and localized intestinal (duodenum) corrugation and what I thought it was a MUCOCELE in the gallblader! (Very classic image see videos). When surgery was done the specialist surgeon confirmed the rupture of the gallbladder but when he went into the lumen of the bladder he only saw mucoid bile but not the classic hard structure like the mucoceles so he did not called it mucocele. So my question is would you make the call of a mucocele with an image like this? or how will you call it? a forming mucocele? I have always called them mucoceles when they have that appearance with striations towards the gallbladder wall. Would love any input on this. Thanks!! Veronica
Comments
yes and bile peritonitis to
yes and bile peritonitis to boot! plasma, vit k and cut yikes very ugly, See the echoenic fat and free fluid how its localized against the GB?? that’s classic perforation or severely inflamed GB. THe Gb has overdistention and immobile striating bile and no neck to speak of which make sit a mucocele in any book. Ugly case.
Here are some similar cases using “Bile peritonitis” as key words in the search.
http://sonopath.com/members/case-studies/search?text=bile+peritonitis&species=All
Awesome! I always call them
Awesome! I always call them mucoceles when i see that appearance. But the surgeon didn’t as it was not a hard structure. I saw the surgery and the content was soft but mucoid. Ohh well. Still will still continue calling them mucoceles then ☺ thanks Eric!
Mucoceles sonographically
Mucoceles sonographically dont always translate into solid gel vs mucoid its still a sick GB if the criteria is met. Bottom line is how the patient did with the GB out:)
I realize that I am late in
I realize that I am late in joining this discussion, but am curious about definitions. Is “gallbladder mucocele” just a gross descriptive term? Is there a single specific histopathological description that supports the diagnosis of a gallbladder mucocele or are there multiple histopathological presentations? I was just thinking about this since the surgeon’s defintion of a gallbladder mucocele based upon what they see may not always agree with the ultrasound definition of a gallbladder mucocele (or emerging mucocele). If there is a consistent corresponding microscopic diagnosis, you could always go to the pathologist to see who was right :).
From Besso Vet Rad US 41(3)
From Besso Vet Rad US 41(3) 2000: Mucoceles are characterized by appearance of stellate or finely striated bile patterns and differ from biliary sludge in that they are not gravity dependent regarding bile movement.
From Gaschen
Vet Clin Small Anim 39 (2009) 439–467
: Gallbladder mucoceles occur in dogs and are an important cause of icterus and obstructive disease. They are caused by cystic mucinous hyperplasia leading to increased mucin production that distends the gallbladder and can eventually cause wall necrosis and rupture. Sonographically, they have a varied appearance. The classic finding is that of a ‘‘kiwi fruit’’ pattern of hyperechoic striations radiating from a central point (Fig. 11). Variations include irregular or striated nongravitationally dependent content or content with a stellate pattern.
From
TSUKAGOSHI:
Veterinary Radiology & Ultrasound, Vol. 53, No. 1, 2012
Gallbladder mucocele is an abnormal accumulation of mucin accompanied by hyperplasia of mucus-secreting epithelium.9, 13, 17 Immobile and finely striated or stellate patterns within the gallbladder lumen are sonographic characteristics of a gallbladder mucocele.13 Although the causes of gallbladder mucocele are unknown, impairment of a protective mechanism on the gallbladder epithelium against bile acids is a significant factor.18 A decrease in gallbladder emptying will result in retention of concen- trated bile in the lumen, which may be an additional factor that promotes gallbladder mucocele in dogs.
EL: From the political and surgical efficiency perspective I think the “Kiwi” label really hurt a lot of dogs because if you dont describe a “kiwi” some surgeons or internists resist sending to sx. Reality and ridiculaous but its true Ive had it happen multiple times. There are no Kiwis in a large part of mucoceles and a perforated mucoele looks like a variation of a smashed kiwi that may have fluid around it or is collapsed and fibrosed because the patient’s body tried to deal wiht it on its own. Just do the mucocele search and you will see.The histopath is mucosal hyperplasia and a variation oof inflammation, infiltrates, fibrosis, infarcts… depends on the case.
Bottom line if + murphy sign, or “ADR” clinical signs with no other reason and you ar estaring at a mucocele wiht striating immobile bile and overdistention, and if you do a GB motility study and its not moving, its useless and needs to come out. They usually inflame at th eneck so when looking for + Murphy (not always present by the way in surgical GB) point to th eneck and cystic duct and see if they tense up on the probe.
A good surgeon of mine tallks about this all the time because a lot of surgeons believe it or not are not up to date on Gb mucoceles and so he pulls our research as examples all the time because he cuts a lot of my GBM dx cases.
Check out Defining a Gb mucocele and our Sx biliary study from Porto ECVIM 2009 if you havent already:
http://sonopath.com/resources/research-publications
Hope this covers your questions and nice post.
Thanks for the references
Thanks for the references Eric!