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To Mucocele or Not to Mucocele

Sonopath Forum

Sonopath Forum

To Mucocele or Not to Mucocele

  • 13 year old Fox terrier presented most recently for anorexia and weight loss
  • Had IMHA some years back that resolved on prednisone therapy which was eventually discontinued
  • Presented some months back for pemphigus foliaceus around the lips which resolved on Doxycycline and Niacinamide therapy.
  • All meds were discontinued but anorexia persists
  • Chemistry profile shows new elevation in liver enzymes:  ALP=432 mcl/L, ALT=777mcl/L
  • Serum bile acids are elevated (post was 75).

    • 13 year old Fox terrier presented most recently for anorexia and weight loss
    • Had IMHA some years back that resolved on prednisone therapy which was eventually discontinued
    • Presented some months back for pemphigus foliaceus around the lips which resolved on Doxycycline and Niacinamide therapy.
    • All meds were discontinued but anorexia persists
    • Chemistry profile shows new elevation in liver enzymes:  ALP=432 mcl/L, ALT=777mcl/L
    • Serum bile acids are elevated (post was 75).
    • ACTH stim shows elevated pre cortisol level of 6.4mcg/dL but normal 1 hour post of 14.3mcg/dL.
    • Abdominal US shows left renal pyelectasia with no obvious obstructions and moderate to markedly enlarged gallbladder full of clumping sludge. The liver parenchyma appeared normal. The gallbladder wall is not thickened and there is no Murphy’s sign.  The intraluminal debris does appear to be at least partially gravity dependent.  The patient was fasted for this study.
    • US guided fna’s were done on the liver as well as cystocentesis for urinalysis and culture.
    • Differential diagnoses for the elevated liver enzymes, elevated bile acids, and anorexia include cholangiohepatitis, chronic hepatitis, infectious disease (Lepto), and neoplasia.  
    • I am hesitant to call this a mucocele due to the above info (gravity dependent, no wall thickening, no inflammation) yet I am not fully comfortable with the appearance of the intraluminal debris.  Any other thoughts?  
    • Would it be ok to include ursodiol as part of medical management or not due to possibility of mucocele formation?  Could the gallbladder be the cause of the anorexia and elevated liver enzymes?