What’s wrong with the liver?

Estómago moderadamente engrosado e inflamado con escaso contenido líquido, compatible con gastritis.
Hepatomegalia moderada con ecogenialidad modernamente disminuida. Vesícula severamente engrosada e inflamada, colecistitis crónica, con escaso contenido anecoico. Se observa más ovalada en lóbulo lateral derecho, isoecoica, heterogénea, granular grueso, con focos anecoicos y otros hiperecoicos con artefacto de cola de cometa (gas). Compatible con neoplasia, absceso con posibles zonas de necrosis y gas.

cyst adenoma?

There appears to be a tremendous amount of increase echogenicity in the liver that I would interpret as inflammation. There is a small thick walled structure in a location consistent with the gallbladder and the increased echo is surrounding that region. I also see what may be fluid between the lobes of the liver and dorsal to the liver. There is an area in the midst of the hyperechoic region which has a branching out appearance and very echogenic which I am not sure how to interpret. There is another area in the right portion of the liver that has a mixed echogenicity that could be consistent with fluid/blood, cystic or neoplasia. I would be concerned about a ruptured gallbladder as the primary problem.

Thickened walked GB, dilated ducts right liver? Obstruction somewhere??

Is there air reverberating in the liver parenchyma

Cystoadenoma ? :)

liver enlarged

and is there a mass with some cysts in the liver?

Gall bladder wall thickening
Cavitated anechoic mass with acoustic shadow
Ddx Cholangitis with hepatic abscess

Pancreas hyperechoic rim and hypoechoic centre and enlarged and distended bile ducts indicating post hepatic obstruction caused by pancreatitis?

total hypoechoi and inhomogeneous liver
It observes the gallbladder constricted with thickened ad irregular walls
on the left there is a nodular lesion disomogeneous with cystic part with and air in the bile ducts (?)
Diagnosis: cholangiohepatitis emphysematous and infiltrative possible neoplastic (cholangiocarcinoma?)
helpful CEUS and biopsy

Very thickened gallbladder wall possibly indication of cholecystitis, in the right liver love there is multifocal areas of hypoechogenicity, as well as areas of hypoechogenicity with reverberation indicating gas. I would say my primary ultrasound dd, would be liver abscessation or hepatitis

liver abscess

Biliary Cystadenoma or cistadenocarcinoma

Hepatic mass and gall bladder wall thickening

Thickened gall bladder possibly secondary to gall bladder rupture (possible small amount of free fluid seen between liver lobes?) Multifocal hypoechoic areas in right liver lobe due to possible liver mass.

There Is gas un the hepatic parenchyma. It looks like Is inside a mass (doesn't look like aerobylia). The liver, gallblader and peritoneum looks edematosus. It looks like an inflamatory desease. Could it be asociate with an hepatic mass with bacterial overgrown? There are some big linphonodes (hepato portales?)Was the dog un pain? The respiratory patern looks like eh was. Sorry for my afwull english... Writting from argentina with my phone in spanish

Bacterial Cholangiohepatitis, possible hepatic abscess ,gas producing anaerobes in the intra hepatic bile ducts, inflammation of the surrounding abdominal fat to name a few. Should do fine with appropriate antibiotics. Fair prognosis.

GB rupture with air in the ducts.

GB rupture with air in the ducts right lobe.

Never see a gb like this.
But liver, Gb, ducts and peritoneum are altered.

Thickened GB wall (ddx lack of distension, edema, cholecystitis) Cystic mass in the right liver with a scant amount of peripheral effusion (local peritonitis) Multiple hyperehoic foci in the mass with reverberation artifact indicating gas (ddx hepatic abscess, infected cystadenoma or other type of tumour)

Liver lobes are rounded.GB only mildly filled with thickening of its wall.There is increased echogenicity of liver hilus and around bile ducts.In the right liver lobe there is round or oval shape well demarkated not encapsulated isoechoic mass with multiple various size hypoechoic fluid filled lesions and high density gas or mineralization changes within the mass. Stomach wall looks abnormal but it's only present partially.Is there small amount of fluid around the lesion or just vessel lying parallel to lesions curvature?Dd: cholangiohepatitis due to
abscess or neoplastic lesions.

Thank you very much for sharing. I will wait very closely for the next challenge. 🙄

Thanks for that case. Looking forward to the next one

thank u so much! and I have some questions about this case.
1. did u FNA the liver before surgery, or Josie wen to surgery directly.
2. wether we need to give some medicals to control this situation first? and what situation need to do surgery immediately?
many thanks!

miranda

I also want to thank you a lot for sharing this.