7-years-old, mixed dog. Presented with vomiting, weight loss and decreased appetite. An abdominal CT-scan was performed.
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).
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).
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).
The pancreas is slightly prominent with a hypoattenuating halo and multiple hypoattenuating stripes consistent with pancreatic oedema (orange arrows).
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
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).
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.
