hx- presented 2012 with long history of gi signs, abdominal pain,itchy. treated with hydrolyzed protein diet,prostura,metronidazole,b12 with good results. Flare ups ocurred but were infrequent and corrected with metrodiazole. IBD was likely working diagnosis. In aug 2013 owner noted a decrease in activity , little motivation to eat but no vomiting ,diarrhea. Abdominal pain possible as the dog hides under furniture. tli ,folat, and b12 levels were normal. chemistry showed albumin at 2.1 and alk phos 291 . acth stim normal. bile acids pending. she was finally scanned. in the cranial abdomen and acoustic shadowing hyperechoic 3 mm structure seen. it is not in the gall bladder,pancreas ,duodenum etc. not seen on radiographs.Is this significant ,what and where is it?? any thoughts???
Comments
Hi Sherri you are in the area
Hi Sherri you are in the area of the cystic duct/common bile duct and this is consistent with a bile stone. There is a lot of localized inflammation around the hypoechoic region (hyperechoic ill defined fat around the hypoechoic tissue). I am having a tough time making out detail here and video would be great especially of the region in the last image. You can see the hypoechoic tissue with ill defined hyperechoic fat and I am betting he had a + murphy sign (pain =on imaging) in that region.
Other potential is a localized mineralizing carcinoma or at times there are LN in that region the blow out their structure from lymphoma but these 2 potentials are less likely. I would explore and expect a friable cystic duct/cbd that may need some reconstruction.Assuming no significant proteinuria, given the low albumin a shopping spree of liver and GI bx also important and a baseline cortisol to ensure no addisons as well.
If going medical only keep and eye on this region with the probe but it looks like it is a festering localized issue.
Thanks that is really what I
Thanks that is really what I thought we had. Bile acids today came back fasted 66 and post prandial 11 so that is supportive. Acth stim was normal too. Yes we had positive murphy sign! My first ductal stone cool stuff. Thanks alot I’ll let you know the outcome.
Hi Sherri you are in the area
Hi Sherri you are in the area of the cystic duct/common bile duct and this is consistent with a bile stone. There is a lot of localized inflammation around the hypoechoic region (hyperechoic ill defined fat around the hypoechoic tissue). I am having a tough time making out detail here and video would be great especially of the region in the last image. You can see the hypoechoic tissue with ill defined hyperechoic fat and I am betting he had a + murphy sign (pain =on imaging) in that region.
Other potential is a localized mineralizing carcinoma or at times there are LN in that region the blow out their structure from lymphoma but these 2 potentials are less likely. I would explore and expect a friable cystic duct/cbd that may need some reconstruction.Assuming no significant proteinuria, given the low albumin a shopping spree of liver and GI bx also important and a baseline cortisol to ensure no addisons as well.
If going medical only keep and eye on this region with the probe but it looks like it is a festering localized issue.
Thanks that is really what I
Thanks that is really what I thought we had. Bile acids today came back fasted 66 and post prandial 11 so that is supportive. Acth stim was normal too. Yes we had positive murphy sign! My first ductal stone cool stuff. Thanks alot I’ll let you know the outcome.