Case Corner

Morsel, a 14 year old intact male Italian Greyhound, is a strong minded, recurrent visitor of Veterinary Specialty & Emergency Care. He had two previous surgeries within the past year to remove diseased salivary glands. However, on this visit the owner presented him for a rapid onset of difficulty walking on his rear limbs. Morsel had a history of being landed on, by his 100 pound canine companion, two days previously. The owner felt that he seemed normal immediately following the incident and was initially not worried, but things changed rapidly just hours prior to presentation to VSEC.

Morsel normally rules the roost and doesn’t take kindly to being handled by anyone other than his owner. We knew something was truly wrong with him on presentation because not only was he having problems walking, but he was also not growling or trying to nip at us during his examination. He had a fever and he was very lethargic. He also had a problem with his lower back as his rear limbs were wobbling around while attempting to walk (paraparesis). He did show some pain response during examination of his back, helping us further localize where his problem was.

Typically patients with back pain present with varying degrees of problems ranging from pain only, to being completely unable to use or feel their limbs. Though most back patients do not have a change in demeanor, with the exception of some getting more upset when being handled because they are uncomfortable. Morsel on the other hand, appeared more tolerant of being handled and this supported the hunch that he was systemically ill. His initial work up plan consisted of performing bloodwork and starting him on supportive IV fluids. The bloodwork revealed several problems: 1) low glucose (likely causing his lethargy); 2) elevated liver values (suggesting a liver problem); 3) dehydration; and 4) elevated white blood cell count (suggestive of infection or inflammation). Morsel was immediately started on supplemental glucose, antibiotics and other supportive medications. The next step was to obtain some images of Morsel’s spine, chest and abdomen. Spinal radiographs revealed an area on adjacent vertebrae (bones that make up the spine) that was suggestive of a spinal bone infection (discospondylitis).

See images

His abdominal radiographs revealed that there was a gas pocket within his liver, a very unusual finding (see images).

An abdominal ultrasound was also performed and confirmed that he had a localized pocket of gas and fluid within his liver. His condition was critical as it appeared that Morsel had an abscess in his liver. This is an uncommon, but truly life-threatening situation. Although the treatment of his spine would likely improve with appropriate antibiotic therapy alone, the treatment of any abscess typically requires drainage. The best way to promote drainage was to surgically drain the liver abscess, but given his critical state, it was decided that surgery was not the right thing to do at this point. So we came up with a creative approach that allowed us to avoid surgery, but still give Morsel a chance. Morsel was given supportive therapy overnight to further stabilize him for the following day’s procedure. The next morning Morsel was heavily sedated and a catheter was placed through his skin into the liver abscess using the ultrasound to allow for accurate catheter placement. This catheter allowed the abscess fluid to drain out of his body, thus avoiding surgery and the recovery process associated with it (see images). Fluid was drained initially and submitted for culture and antibiotic sensitivity. Morsel recovered from anesthesia and did well overnight with more fluid being collected from his percutaneous (through the skin) liver catheter, which had been sutured in place. In fact, the next day he was able to walk much better and his fever had resolved. Morsel was also starting to get his normal personality back. Over the next 24 hours he continued to improve so the catheter was removed. Morsel’s appetite quickly returned and he was discharged after only 3 days of being in the hospital. Since his discharged, he has continued to improve. Recheck bloodwork, ultrasound and radiographs of his liver demonstrated that the liver abscess has been completely resolved.