This week’s case is an 8 year old male neutered German Shepherd cross with a 48-hour history of lethargy, pale mucous membranes, and a distended abdomen. Bloodwork indicates anemia, neutrophilia, thrombocytopenia, increased ALT and AST, increased CK and GGT, decreased cholesterol and T4.
There is increased soft tissue opacity in the cranial abdomen with caudal displacement of the stomach and small intestine. The abdomen is distended, and there is mottled peritoneal detail in the cranioventral region.Â There is also a gas lucency overlying the dorsal portion of the liver. This may be overlying bowel, or be within the hepatic parenchyma.
The ultrasound exam shows a liver infiltrated with multiple masses. The masses are of mixed echogenicity, and deform the capsule of the liver. Within one of the masses, there are multiple hyperechoic foci with distal “dirty” acoustic shadowing. The dirty shadowing indicates gas, while clean shadowing would indicate mineralization.
- Hepatic mass
- Splenic mass
Hepatic carcinoma with suppurative effusion and hemorrhage.
The cranial location of the mass effect makes the most likely differential diagnosis a hepatic mass. A splenic mass is possible, however these are more often in the mid abdomen and better delineated. The gastric axis is faintly visible caudal to the mass, supporting a hepatic origin.
The distended abdomen and poor detail are diagnostic of peritoneal effusion. The compression of abdominal organs is also contributing to poor viewing of serosal surfaces.
Hepatic abscesses in dogs can be caused by liver lobe torsion, infection secondary to diabetes mellitus, systemic sepsis, or within masses. The infection is often anerobic, with E. coli spreading from the gastrointestinal tract.
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