Ultrasound & Liver Disease:Worth It?

Cholangitis, a common inflammatory disorder of the biliary system in cats, often occurs in conjunction with cholangiohepatitis. The cholangitis/cholangiohepatitis complex in cats is subdivided into 3 categories: neutrophilic and lymphocytic cholangitis (the 2 major categories) and chronic cholangitis associated with liver fluke infestation.

This retrospective study evaluated 26 cats with a histologic diagnosis of neutrophilic (n = 12) or lymphocytic (n = 14) cholangitis for ultrasonographic changes to the liver, biliary system, pancreas, and small intestine. The study sought to determine whether cholangitis can be diagnosed based on these changes and differentiating the disease subtype is possible. However, no statistically significant ultrasound changes were found that could distinguish the forms. Although not significant, there was a tendency for cats with neutrophilic cholangitis to demonstrate sonographic evidence of an enlarged pancreas. Most cats had sonographically normal liver size and echogenicity as well as normal biliary systems. Statistically significant changes in cats with cholangitis included hyperechoic liver parenchyma, hyperechoic gallbladder contents, and increased pancreatic size. These parameters may be useful for diagnosing cholangitis.

CommentaryUnfortunately, ultrasound cannot definitively diagnose specific causes of liver disease, which is why cytology, biopsy, and/or culture are often indicated. In one study, hyperechoic livers (relative to falciform fat) showing beam attenuation had 91% sensitivity, 100% specificity, and 100% positive predictive value for feline hepatic lipidosis.¹ This is a likely explanation for why cats in this study had hyperechoic livers—there was probably concurrent lipidosis (many presented with decreased appetite). Of importance, these patients often had pancreatitis and/or inflammatory bowel disease as well as cholangitis (often referred to as triaditis). I believe, therefore, that it is worthwhile to sonographically evaluate the entire abdomen for any hepatic, GI, or pancreatic lesion; biliary obstruction; and related issues.—Jean K. Reichle, DVM, MS, DACVR

SourceUltrasonographic findings of feline cholangitis. Marolf AJ, Leach L, Gibbons DS, et al. JAAHA 48:36-42, 2012.

1. Accuracy of ultrasonography in the detection of severe hepatic lipidosis in cats. Yeager AE, Mohammed H. Am J Vet Res 53:597-599, 1992.