Ruptured gallbladder

Sonopath Forum

Sonopath Forum

Ruptured gallbladder

  • 2 year old cat presented following RTA – soft tissue swelling ventrum and scuffed nails; suspect RTA or kick
  • Was managed conservatively and rad showed mild pleural effusion
  • Represented 24 hours later jaundiced and inappetant, severe elevation in liver enzymes

    • 2 year old cat presented following RTA – soft tissue swelling ventrum and scuffed nails; suspect RTA or kick
    • Was managed conservatively and rad showed mild pleural effusion
    • Represented 24 hours later jaundiced and inappetant, severe elevation in liver enzymes
    • The gallbladder wall was thickened and collapsed so I suspected rupture. I think liver was hypoechoic with increased portal markings. There was a small volume of abdominal effusion and cranial abdominal free fluid. The pancreas looked fairly normal. There was a severe pleural effusion with normal cardiac examination.
    • The abdominal fluid and the pleural fluid was yellow/orange/bile colour. Fluid analysis pending. I am not sure if the fluid aspirated was bile or just this colour as the cat was jaundiced.
    • Do you think this is ruptured gallbladder?
    • Why was there so much pleural effusion? Diaphragmatic tear, vasculitis? The lung looked consolidated on scan, no sign of torsion on initial thoracic rad. 
    • Any suggestions welcome. 

Comments

EL
April 28, 2019 at 6:24 pm -

The gb is empty here and when

The gb is empty here and when a rupture occurs there is usually hyperechoic ill-define  fuzzy reactivity next to it. This isnt absolute but the normal in my experience. I think this is just empty and the cystic duct and cbd look fine. I would drain the chest and to a chest CT with contrast to see whats going on there and fna the liver. Acute hepatitis likely or could the trauma all be incidental and there was something going on before? I think CT is your answer here but the radiologist will see much more once the fluid is drained before the CT.

veteurope1
April 28, 2019 at 6:42 pm -

Thanks EL, i have never seen

Thanks EL, i have never seen a gallbladder like this. The cat wasn’t eating so I would have thought it wpuld be full but maybe spontaneous contraction. The cat was not jaundiced initially. I thought there was steatitis caudal to the liver on the last video. It is not piecing together so I will suggest a CT.

rlobetti
April 28, 2019 at 7:04 pm -

Also consider pre-existing

Also consider pre-existing hemoplasmosis which resulted is a slower and weaker cat that then suffered from trauma.

Liz
May 14, 2019 at 5:47 am -

What was the outcome of this

What was the outcome of this case? 

veteurope1
May 14, 2019 at 6:22 am -

I was not managing it but the

I was not managing it but the pleural effusion was suspected to be bile by the lab and the cat made a great improvement following drainage and supportive care. He went home seeming completely normal. I will check the repeat bloodwork too.

Liz
May 14, 2019 at 6:25 am -

Crazy. I had a uroabdomen

Crazy. I had a uroabdomen (back in the day when I could handle emergency medicine!) once that had bicavitary effusion. I could understand the abdominal fluid (obv) but couldn’t figure out the pleural effusion. Apparently, its a thing that can happen with ruptured bladders. I was wondering reading through your case if you could have a similar cause for the pleural effusion, but I don’t know the pathophysiology of it….

Thanks for the update.

veteurope1
May 14, 2019 at 6:33 am -

https://www.ncbi.nlm.nih.gov/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480630/

 

I found this article while researching and gives some possibilities at the end. Very interesting. 

Liz
May 14, 2019 at 6:35 am -

Fascinating! Thanks!

Fascinating! Thanks!

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