- 9yr old FS Poodle mix that presented in June for elevated liver enzymes and decreased energy
- Ultrasound done at that time showed normal hepatic parenchyma, mild hepatic venous congestion, and a gallbladder full of sludge with no pericholecystic inflammation and no Murphy’s sign (see still image).
- Liver enzymes have progressed and decreased energy has persisted despite medical management with antibiotics, ursodiol, and nutraceuticals
- 9yr old FS Poodle mix that presented in June for elevated liver enzymes and decreased energy
- Ultrasound done at that time showed normal hepatic parenchyma, mild hepatic venous congestion, and a gallbladder full of sludge with no pericholecystic inflammation and no Murphy’s sign (see still image).
- Liver enzymes have progressed and decreased energy has persisted despite medical management with antibiotics, ursodiol, and nutraceuticals
- Recheck ultrasound done today shows coalescing, septated anechoic cysts in the left liver, dilated gallbladder full of sludge and possible stones in the bladder neck, but still no pericholecystic inflammation.
- Ultrasound guided fna of the liver and cyst were done and cytology is pending. The hepatic cystic fluid was a translucent yellowish-orange color. Opted out of core biopsy today due to the small window between the large cysts and the gallbbladder, but it probably is doable.
- My primary differentials for the liver are hepatic carcinoma, biliary carcinoma, and benign cyst (unlikely due to rapid growth). My primary differentials for the gallbladder are cholecystitis, cholelithiasis, and emerging (:)) GB mucocele.
- If the aspirates are nondiagnostic, should I go back for the core biopsy or would surgical laparotomy with liver resection and cholecystectomy be a better option?
The first picture is from June. The rest are from today.
Comments
Just to add…the echogenic
Just to add…the echogenic nodule you see at the end of the first clip is actually the gallbladder coming into view. In the second clip, the gallbladder is on the left, and the stomach comes into view on the right.
Looks like a primary hepatic
Looks like a primary hepatic cyst and a lipogranuloma but fna the periphery of the cyst, drain the cyst and culture and fna the nodule to be complete. Could justify actigal for that gb as well.
Seeing that it can take a
Seeing that it can take a while to drain a large cyst, do you worry about lacerating the liver capsule? Would you use a catheter instead of a 1 and 1/2 inch needle? The patient was sedated but obviously, respiratory motion continued.
20 gauge long IV catheter or
20 gauge long IV catheter or Myla cath would do fine. Under sedation usually mninimal to no leaking but has never been an iussue iV fluids and abs during the procedure.