Nice images. The images of
Nice images. The images of the Gb shows polypoid hyperplasia and suspended debris but no real distention which defines a mucocele but this is largely subjective. Yes I would use actigall here because of breed predisposition to mucoceles but this is not a complete mucocele and a bit of a reach for “emerging mucocele” but still immobile suspended sludge can be an issue clinically. The actigal cleaned it up well as well as indicated but would need the prior images to compare. I would recheck ideally in a month off the actigal to see what it does but may be overkill. Or better yet do a GB motility study and if it isnt working and tit continues to want to be a mucocele then just remove it and do a liver bx at the same time.

See our article on defining a Gb mucocele and our ecvim abstract on surgical biliary disease in resources

The d-pap I measure in long axis when its clinical and measure the cbd just before it to I measure the papilla and the tube leading to it.

Good first post congrats! Videos help even more when evaluating mucoceles so you can upload those as well in avi or similar and the site converts them automatically if uploaded in the criteria written at the upload tab.

Correct on the GB shape but
Correct on the GB shape but also breed dependent. Mucoceles in GSD are long though but the cystic duct is dilated as well. There are no hard rules band many definitions which is why I wrote the GB mucocele survey in resources and tapped the minds of 8 clinical sonographers that I fully trust and make a living on these exact decisions.

This is one of th early mucocele articles that defined the mucocele but just google and you will come up with tone or IVIS.org or pubmed

ULTRASONOGRAPHIC APPEARANCE AND CLINICAL FINDINGS IN 14 DOGS WITH GALLBLADDER MUCOCELE
JG BESSO,DEDV, RH WRIGLEYB,VSc, MS DVR, JM GLIATTOV,MD, CRL WEBSTERD,VM
Fourteen dogs with enlarged gallbladders and immobile stellate or finely striated bile patterns on ultrasound are described. Smaller breeds and older dogs were overrepresented, with 4/14 Cocker Spaniels. Most dogs presented for nonspecific clinical signs such as vomiting, anorexia and lethargy. Abdominal pain, icterus and hyperthermia were the most common findings on physical examination. All dogs except one had serum elevation of total bilirubin andlor alkaline phosphatase, alanine ami- notransferase and gamma glutamyl transferase. All dogs were diagnosed with a gallbladder mucocele upon histologic and/or macroscopic evaluation. Ultrasonographically,mucoceles are characterized by the appearance of the stellate or finely striated bile patterns and differ from biliary sludge by the absence of gravity dependent bile movement. On ultrasound, gallbladder wall thickness and wall appearance were variable and nonspecific. The cystic or common bile duct were normal sized in 5 dogs although all 5 had evidence of biliary obstruction at sungery or necropsy. Loss of gallbladder wall integrity bnd/or gallbladder rupture were present #in50% of the dogs, all located in the fundus. Gallbladder wall discontinuity on ultrasound indicated rupture whereas neither bile patterns predicted the likelihoodof gallbladder rupture. Pericholecystichyperechoicfat or fluid were suggestiveof but not diagnostic for a gallbladder rupture. Cholecystectomy appears to be an appropriate treatment for mucoceles, if not to treat a gallbladder rupture, at least in most dogs to prevent it since gallbladder wall necrosis was identified by histology in 9 of 10 dogs. Mucosal hyperplasia was present in all gallbladders examined histologically. Positive aerobic bacterial culture was obtained from bile in 6 of 9 dogs. Cholecystitis was diagnosed histologicallyin 5 dogs and 4 dogs had signs of gallbladder infection solely upon bacterial bile culture. Gallbladder infection was not present with all the mucoceles suggestingthat biliary stasis and mucosal hyperplasia may be the primary factors involved in mucocele formation. Based on the results of our study, we suggest two alternate courses of action in the presence of a distended gallbladder with an immobile ultrasonographic stellate or finely striated bile pattern: a cholecystectomy when clinical or biochemical signs of hepatobiliary disease are present or a medical treatment (antibiotics and cboleretics) and patient monitoring by follow-up ultrasound examinations when the patient does not have clinical or biochemical abnormalities. An aerobic bile culture should be obtained in all patients, by ultrasound-guided fine needle aspirate or at surgery. Veterinary Radiology
& Ultrasound, Vo. 41, No. 3, 2000 p p 261-271
Key words: gallbladder, dog, ultrasonography, mucocele, mucosal hyperplasia, cholecystitis.