Global (English)
Granulomatous nodular hepatitis with associated bile stasis
Identification and history
- Name: Scar
- Report and medical history: Pogona Vitticeps, female, 8 years old.
An ultrasound was requested due to the non-specific clinical history of anorexia, prostration and detection, through palpation, of an increased volume in the area of the coelomic cavity corresponding to the liver.
At the time of the initial examination, biochemistry values were within the range considered normal for the species.
Diagnostics
The liver is enlarged in size with rounded margins, parenchyma deformed by several oval-shaped masses, with regular contours and variable degrees of heterogeneous echostructure.
The largest mass measures approximately 3 cm in long-axis diameter.
Distended gallbladder, thickened and irregular wall, showing mobile echogenic sediment in the slopes and hyperechogenic punctures with some posterior acoustic shadowing.
FNA was performed for cytological evaluation.
Images were acquired using the MyLab™Omega VET system.
Conclusions and treatment
The characteristics of the liver masses and the animal's clinical picture were suggestive of neoplasia (primary or secondary) or severe chronic nodular hepatitis. An echo-guided aspiration puncture was performed for subsequent cytological analysis. (d.d: hematoma, abscess).
The changes observed in the gallbladder were extremely suggestive of cholangitis with associated stasis/delay in biliary emptying. Neoplastic etiology was less likely but couldn´t be categorically ruled out.
FNA was performed to cytological evaluation.
We suggested repeating the FNA or performing a biopsy for confirmation histopathological analysis, but the owners ended up not wanting to perform any more tests.
Cytological report
The samples show moderate cellularity, with a hematic and lipid component. A mixed cell population consisting of macrophages is present, reactive, rarely multinucleated, and associated with lipid material. Rare groups of compatible monomorphic epithelial cells are observed with hyperplastic biliary epithelium, as well as occasional clusters of bluish, mucinous material.
Bearded dragons have a high frequency of hepatic lipidosis, which may occasionally have a granulomatous component.
No aetiological agents were identified in this case, but although granulomatous inflammation in reptiles is rather non-specific, it cannot be excluded.
It should also be noted that the presence of mucin associated with biliary epithelium may be associated with biliary stasis, possibly focal.
Dr. Miriam Vistas, DVM
Dr. Mário Nóbrega, CEO and Founder at Exoticvets, Lisboa, Portugal
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