Liver ultrasonographic changes with only mild liver enzyme elevations

RE: Liver ultrasonographic changes with only mild liver enzyme elevations

Roger Wilkinson — Thu, 28 Jan 2021 22:12:30 GMT

Hi Emily,

Are they just hyperechoic? If so then probably more likely to be benign nodular hyperplasia at that size. If they have a hypoechoic ring outside a hyperechoic centre then 'target lesions' and that is associated with @ 80% probability of malignancy in published case series.

On the whole I'd usually expect higher ALT with disseminated malignancy in liver.

Have you ultrasound scanned lungs? That's definitely not referral level. Easy enough to distinguish normal vs interstitial syndrome/oedema (B lines), neoplasia (hypoechoic areas without hyperechoic gas densities), pneumonia ('shred sign' hypoechoic areas with gas densities), pleural effusion. In a coughing dog who has become inappetent that would be my first stop.

best wishes

Roger

RE: Liver ultrasonographic changes with only mild liver enzyme elevations

Anthony Dennison — Mon, 25 Jan 2021 15:00:57 GMT

I once sat through a 2 hours lecture at BSAVA years ago that was entitled 'is this liver normal on ultrasound?'

In summary: You can't tell from images alone. They can look horrendous and just be regenerative nodules or a vacuolar hepatopathy due to steroids, or it could be something neoplastic.

Things it could be - hepatic cysts, neoplasia, hepatitis, abscesses.

Best thing to do would be a liver biopsy - via ex-lap rather than using percutaneous sampling like tru-cut as you need to get multiple portal triads within the sample for the pathologists to give you a good answer.

Prior to liver biopsy always get a coagulation profile done too due to the risk of bleeding. If PT/aPTT are delayed then it could also indicate impaired liver function

RE: Liver ultrasonographic changes with only mild liver enzyme elevations

Iain Richards — Thu, 21 Jan 2021 13:39:29 GMT

CAn't realy comment on the ultrasound as I can only just identify liver! However, the bloods are essentially normal. The liver could of course be cirrhotic and with few hepatocytes left, the ALT can't get much higher. (What's GLDS? google failed me, but do you mean GLDH?)
Old dog bronchitis plus old dog liver change?