Lethargy and inappetence; jaundice and pyrexia
A CT scan has been performed, to assess the integrity of the gallbladder and attenuation of the nodular aspect of the duodenal papilla. CT results: Moderate to markedly distended gallbladder with the caudal margin extending beyond the hepatic margins. The gallbladder wall is mildly diffusely thickened measuring 1.6 mm. No changes have been seen at the level of the local peritoneal space. The peritoneal space surrounding the gallbladder is normal. The cystic duct and common bile duct (orange arrows) are mildly and markedly distended by fluid measuring 4 mm and up to 6.9 mm in diameter, respectively. The wall of the cystic and common bile duct is mildly diffusely thickened. At the level of the junction between the common bile duct with the duodenal papilla, there is ill defined hyperattenuating structure (green circle). The duodenal papilla is mildly thickened and has faint central contrast enhancement. There is mild regional peritoneal effusion in this region (light blue arrows). The liver is normal in shape and margination. In the caudodorsal aspect of the right division of the liver there is an intrahepatic biliary duct (green arrow) mildly distended by fluid measuring 2.5 mm in diameter and its wall is mildly diffusely thickened. The pancreas (red arrows) is mildly to moderately enlarged measuring 5.6 mm on the right limb, 10 mm in the body and 8.5 mm on the left limb. At the tip of the limb of the pancreas there is a focal ill-defined isoattenuating and contrast enhancing thickening that deforms the pancreatic capsule (pink arrows) and measures approximately 9.2 x 7.3 mm. There is mild to moderate fluid and fat stranding surrounding the pancreas (light blue arrows), notably the left limb. The pancreatic duct (dark blue arrows) is moderately diffusely distended by fluid measuring up to 3 mm in the pancreatic body.
Ultrasound is used in the diagnosis of feline hepatobiliary disease. Ultrasound abnormalities in cats with cholangiohepatitis and cholecystitis include gallbladder wall thickening, choleliths, bile ducts thickening and dilation, enlarged pancreas, and gallbladder sludge. Gallbladder wall thickening can be found with cholecystitis, cholangitis, oedema, cystic mucinous hyperplasia, pericholecystic free fluid, and systemic disease unrelated to the gallbladder. Inflammatory processes involving the biliary and pancreatic tract can be associated with amorphous plugs, cholelithiasis, neoplasia, fibrotic tissue, foreign body. although it is often difficult to determine what came first (Mayhew et al. 2002). The common biliary duct, pancreatic duct and duodenal papilla must be evaluated thoroughly for the presence of echogenic amorphous plugs and choleliths, which may or may not cause acoustic shadowing.
Even ultrasound examination is used usually in diagnosis of liver and biliary tract pathologies, CT scan is better in evaluation the hepatobiliary disorders, possible nodules, attenuation and gives a perfect 3D view of the local anatomy.
In this case, the patient has been managed symptomatically, blood results improving gradually in a 5-day course, full recovery being achieved. In the presented case the main differential diagnosis was between duodenal papilla obstruction from inflammation/infection versus neoplasia. Response to therapy supported inflammation/infection.
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