Chronic hepatitis with hepatic cirrhosis and portal hypertension in a dog

7-year-old mixed dog

7-years-old, mixed dog. Presented with vomiting, weight loss and decreased appetite. An abdominal CT-scan was performed.

7-year-old mixed dog

Description

The liver is severely reduced in size, with markedly rounded margins, especially on the left side. The left medial and lateral liver lobes are severely reduced in size, with rounded margins, and homogeneous pre- and post-contrast attenuation (orange arrows). The remaining liver lobes are also decreased in size, although less severely, with a nodular appearance, showing slightly heterogeneous soft tissue attenuation and post-contrast enhancement, with multiple ill-defined hypoattenuating areas (blue arrows).

dog, CT, abdomen, liver lobes
dog, CT, abdomen, liver lobes

The portal vein, at its extra and intrahepatic portions, and the hepatic veins are surrounded by a hypoattenuating halo/region, which is quite severe in the cranial abdomen and less severe in the remaining portions, consistent with severe perivascular oedema (green arrows). 

dog, CT, abdomen, portal vein
dog, CT, abdomen, portal vein
dog, CT, abdomen, hepatic and renal vessels

Adjacent to the hepatic vessels, in the left cranial abdomen, there is a small network of tortuous vessels, without being able to follow its path, consistent with gastroesophageal varices (purple arrows). In addition, there is a small network of tortuous vessels in the region surrounding the cranial mesenteric artery and renal vessels, medial to the left kidney, consistent with gastrophrenic varices (red arrows).

dog, CT, abdomen, hepatic and renal vessels
dog, CT, abdomen, hepatic and renal vessels

The pancreas is slightly prominent with a hypoattenuating halo and multiple hypoattenuating stripes consistent with pancreatic oedema (orange arrows).

dog, CT, abdomen, pancreas

Some of the mesenteric lymph nodes (hepatic, splenic and colic lymph nodes – blue, orange and green arrows respectively) are slightly prominent, decreased in attenuation and with reduced post-contrast enhancement

dog, CT, abdomen, mesenteric lymph nodes
dog, CT, abdomen, mesenteric lymph nodes
dog, CT, abdomen, mesenteric lymph nodes

There is a scant amount of peritoneal fluid surrounding the abdominal organs, visible between the intestinal loops (green arrows). In addition, the peritoneal fat has a diffusely and slightly increased attenuation, with presence of fat stranding (blue arrows).

dog, CT, abdomen, intestinal loops
dog, CT, abdomen, intestinal loops

Diagnosis

  • Severely reduced in size liver (left side>right) with nodular appearance, with rounded margins and areas of heterogeneous attenuation. These changes are most likely consistent with hepatic cirrhosis, most likely secondary to chronic hepatitis. Associated with these changes, there are changes consistent with portal hypertension:
    • Very severe perivascular oedema surrounding the portal vessels and hepatic vein.
    • Pancreatic and mesenteric oedema.
    • Presence of gastrophrenic and gastroesophageal varices, consistent with acquired portal collateral circulation.
    • Scant amount of peritoneal effusion.
  • Mild mesenteric lymphadenopathy, which could be reactive associated with the hepatic abnormalities vs edematous lymph nodes secondary to portal hypertension cannot be excluded.
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Lobar pneumonia with abscess caused by inhalation of a foreign body in a dog.

2-years-old, mixed breed dog. Presented for coughing episodes and suspected abscess caused by foreign body. A thoracic CT-scan was performed.

Description

The accessory lung lobe is almost entirely consolidated, being increased in attenuation with presence of an air bronchogram at its dorsal and medial aspect and a cavitary lesion at its ventral aspect. The area of alveolar pattern shows a slightly heterogeneous enhancement (blue arrows). The cavitary lesion presents multiple cavities within it that appear to be connected with each other, with fluid attenuating, non-contrast enhancing material and multiple gas bubbles, being surrounded by a thick capsule that shows marked post-contrast enhancement (red arrows). These lesions are in close contact with the diaphragm and with the cardiac silhouette in the region adjacent to the left ventricle. The caudal vena cava (CVC) is located to the right of the consolidated lobe, in intimate contact with the area of alveolar pattern, without being in contact with the cavitary lesion or involved in it.

dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe

In the left caudal lung lobe, there is a focal and tubular bronchiectasis of the lobar bronchus up to its most peripheral aspect (blue arrows) with the bronchus correctly aerated. In its more peripheral aspect, at the most caudodorsal aspect of the lung lobe, associated to the area of bronchiectasis, there is a focal area with slightly ill-defined margins, increased attenuation (pink arrows) associated with a pleural band (orange arrows), causing a small indentation on the surface of the lung lobe.

dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe
dog, CT, thorax, lung lobe

In the left caudal lung lobe, there is a focal and tubular bronchiectasis of the lobar bronchus up to its most peripheral aspect (blue arrows) with the bronchus correctly aerated. In its more peripheral aspect, at the most caudodorsal aspect of the lung lobe, associated to the area of bronchiectasis, there is a focal area with slightly ill-defined margins, increased attenuation (pink arrows) associated with a pleural band (orange arrows), causing a small indentation on the surface of the lung lobe.

dog, CT, thorax, lymph nodes
dog, CT, thorax, lymph nodes
dog, CT, thorax, lymph nodes

Diagnosis

  • Alterations in the right accessory lung lobe consistent with lobar pneumonia and abscess most likely associated with inhaled foreign body, even if the foreign body is not clearly visible in the CT. Consider that, given that the lesion consistent with an abscess is in intimate contact with the diaphragm and the cardiac silhouette, the presence of adhesions in these structures cannot be ruled out.
  • Alterations in the left caudal lung lobe, at its caudodorsal aspect, consistent with pneumonic focus with pleural adhesion and bronchiectasis of the main bronchus, associated with migration of the inhaled foreign body.
  • Mild sternal and tracheobronchial lymphadenopathy, most likely reactive.
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