June 2018 Sonopath Case of The Month: Chronic Cholangiohepatitis in a 1-year-old FS Australian Shepherd Mix

June 19, 2018
Animal Sounds NW

Chronic Cholangiohepatitis in a 1-year-old FS Australian Shepherd Mix


All we know is “If it’s sick it needs a probe” and if you’re treating, it needs a follow-up probe. Who knows what this young dog got into?

Presented for acute onset of collapse with hepatomegaly on radiographs, this dog was scheduled for immediate ultrasound. Given a guarded prognosis, the recommended treatment protocol was followed and a repeat scan performed 48 hours later revealed dramatic improvement and markedly less pain.

Thanks to the quick response and dedicated care of Dr. Maniar at Rockaway Animal Hospital, this young dog didn’t sit in a cage for 24-48 hours with no direction; instead after an initial ultrasound by SonoPath Mobile’s own Diane McFadden, RVT, SDEP™ certified clinical sonographer, 48 hours later she was well on the road to recovery and ready for outpatient treatment. The patient is reported to be doing great following her treatments.


A 1-year-old, FS, Australian Shepherd mixed breed canine was presented for acute onset of collapse/dizziness. This was the first episode that the patient ever had; patient was BAR prior. Hepatomegaly was seen on radiographs. Blood chemistry showed an elevated ALT, CBC/UA were WNL. 4DX heartworm test was positive, Lepto test was negative.

Image Interpretation

The liver was swollen and hypoechoic with a double layered gallbladder. The liver revealed coarse
architecture with increased portal markings. This is consistent with acute on chronic cholangiohepatitis.


Chronic cholangiohepatitis and free fluid. Pancreatic edema.


The pancreatic edema and free fluid was likely owing to portal hypertension. Liver biopsy was suggested in this case. Treatment for acute on chronic cholangiohepatitis with coverage for Leptospirosis was recommended even though the patient is negative. Copper storage was a possibility. A very guarded prognosis was given. A recheck ultrasound was performed 2 days later which revealed structurally resolved cholangiohepatitis, normalized gallbladder, and largely resolved pancreatitis. The presentation was dramatically improved compared to the prior sonogram. Outpatient therapy was recommended as long as the patient was stable. The patient was treated with I.V. fluids, metronidazole, ampicillin, and Pepcid followed by heartworm treatment protocol of prednisone and doxycycline. The patient is reported to be doing great following her treatments.