Case Index - November 2003 - Case of the Month.
Click on an image for a larger view and scroll down to the bottom for the final answer.
Spots: 14 year old, Male, Castrated, Cocker Spaniel
History: Previously diagnosed with Addison's Disease and started on predisone. Seizures were controled with phenobarbital.
Presented with mildly elevated liver enzymes and hypoalbuminemia, elevated bile acids, increasing lethargy.
Two images are provided of the Liver
List Differentials (Scroll to bottom for answer)
Answer:
Well, Spots went to surgery for the cholecystectomy and partial splenectomy (see cases August, September and October!) and the liver was smaller than normal, very firm and irregular in contour (see below). Histology revealed widespread, severe bridging fibrosis consistent with cirrhosis.
Cirrhosis has a classic appearance of very small size, irregular contour, nodular regeneration ("lumpy-bumpy") with ascites. However a retrospective study found this combination of findings in less that 20% of all the dog's with moderate to severe bridging fibrosis in the liver. Sonographers need to keep cirrhosis on the list of differentials in spite of a normal liver appearance. The portal hypertension and hypoalbuminemia caused the pancreatic edema and, possible, the seizures. The other finders were unrelated, although we do not know the cause of cystic mucinous hyperplasia ("mucocele" (sic)) in gall bladders of dogs.
