Case of the week 3.27.23
Publication Date: 2023-03-26
3 images
Findings
Abdomen - ventrodorsal and lateral radiographs are available for interpretation.
Abdominal serosal detail is normal.
There are numerous, stippled to angular, mineral opaque foci in the gallbladder and throughout the hepatic parenchyma which are suspected to be within the biliary tract, given the linear/arborized appearance. The liver is mildly enlarged with rounded margins extending beyond the costal arch. Best identified on the ventrodorsal radiograph, there is focal accumulation of this mineral superimposed with the proximal portion of the descending duodenum.
The stomach contains a small to moderate volume of gas and homogeneously soft tissue/fluid opaque material. The small intestines contain a small volume of homogeneously soft tissue/fluid opaque material and scant volumes of gas. The colon contains a small volume of heterogeneous fecal material and gas.
The kidneys have mildly undulant margins and contain multiple punctate to linear mineral opacities. There are numerous, small, well-marginated, round, faintly mineral opaque foci within the urinary bladder. The spleen is normal.
There is a small volume of mineral opaque material superimposed with multiple small intestinal segments on the ventrodorsal radiograph. On the lateral radiograph, this material is present superimposed with the retroperitoneal space at the level of the fourth lumbar vertebra.
Diagnosis
- Severe cholelithiasis and choledocholithiasis with suspected accumulation of mineral opaque material at the level of the duodenal papilla likely resulting in at least partial obstruction, given the reported clinical signs and labwork abnormalities. The planned abdominal ultrasound is recommended for further evaluation.
- Moderate hepatomegaly is non-specific, but likely represents a benign processes such as vacuolar degeneration or nodular hyperplasia. Malignancy (such as infiltrative round cell neoplasia) is considered less likely.
- Bilateral chronic renal degenerative changes and nephrolithiasis. Cystolithasis.
- The appearance of the gastrointestinal tract is most consistent with a non-specific gastroenteritis, given the reported vomiting.
- The mineral opaque material superimposed with the right caudal abdomen at the level of the fourth lumbar vertebra is suspected to represent mineralization of the extra-abdominal soft tissues.
Discussion
An ultrasound was performed and confirmed that there was biliary obstruction. The patient underwent a cholecystectomy.
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