Presentation
Presents with hunched posture, lethargy, and difficulty defecating.
Patient Data
There is a large fat opaque mass, measuring approximately 10.0 cm in dorsoventral height dorsal to the lumbar vertebral column, sacrum, and caudal vertebra. The liver is moderately enlarged with rounded borders and there is a convexly margined region of the ventral liver immediately caudal to the costal arch. There is poor serosal detail in the region of the liver. The pyloroduodenal junction is widened. A mass effect with displacement of the small intestine is not visualized in this region.
Generalized hepatomegaly with focal enlargement indicating a hepatic mass (adenoma, carcinoma). Hemorrhagic or neoplastic effusion. Lipoma.
There is a large, approximately 6.0 cm x 8.0 cm mass identified deep to the gallbladder within the liver. There is gallbladder wall edema. There is free abdominal fluid. There are multiple hyperechoic nodules identified and multifocal hyperechoic and hypoechoic nodules and regions within the hepatic parenchyma. The liver margin is rounded.
Hepatic mass with peritoneal effusion and gall bladder wall edema.
Case Discussion
Hepatic masses may be adenoma or carcinoma most commonly, and if there is a more fluid component abscess could be considered. This mass was a hepatic carcinoma and was surgically excised. The peritoneal effusion was hemorrhage, as these large masses will often rupture causing hemoperitoneum.
The diffuse changes were a combination of extramedullary hematopoeisis, lipidosis, glycogenosis, and lipogranulomas with mild focal necrosis. The gallbladder was diagnosed as lymphoplasmacytic cholecystitis with moderate serosal edema.
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