Sudden Onset of Jaundice and Anorexia in an 8-year-old DSH Feline: Case Of the Month July 2017
This month SonoPath presents an artistic example of sonographic pathology from one of the original consummate GP sonographers & surgeons of our time, Dr. Robert Hylands of Westbridge Veterinary Hospital in Mississauga, Ontario, Canada. Since the 1980s when clinical sonography entered the veterinary scene in serious fashion, Bob has been at the forefront as a luminary and influencer and has always been one of the top clinincal sonographers. Here is just one more rock star example case of bile duct obstruction in a cat with some hidden pathology to accompany it in true Hylands Picasso fashion. Take a look at this sonographic and surgical display and you will see what we mean. :)
An 8-year-old DSH feline was presented with an acute presentation of jaundice and decreased appetite. He was also pyrexic (40.6 celsius). Blood chemistry: ALT 669, AST 177, TBil 34, ALKP 48, PLI 50, SDMA 14, T4 22. CBC: normocytic normochromic anemia HCT 28% with reticulocyte 11 (<50) non-regenerative. Urinalysis by cysto; spec. gr 1.047, ph 6.5, Bil3+, prot 2+, RBC>50, WBC 3-5, sq ep 1-5, trans ep 1-5. FELV/FIV NEG. Abdominal radiographs clearly demonstrated the presence of a radiopaque density (3 mm) that appears to image in the vicinity of where the major duodenal papilla would be located. The cat has lost almost 0.9 KG (1.9 lbs) over the last year. An abdominal ultrasound was ordered to evaluate the cause of the elevated Tbil and jaundiced appearance of the individual.
The liver displayed signs of cholangitis. The gallbladder wall was thickened, double lined and the mucosal surface was irregular with a feathery appearance. The CBD was distended with anechoic fluid and had a thickened wall as well. The major duodenal papilla had a single cholelith wedged within it and was causing the obstruction. The pancreas was hypoechoic and mottled with hyperechoic poorly outlined densities. The surrounding fat and mesentery were both reactive and markedly hyperechoic. A few mm distal to the area of the papilla was a discreet mass that was originating from the opposite side of the duodenum.