한국임상수의학회지 (Journal of Veterinary Clinics)

  • 제26권4호
  • /
  • Pages.367-370
  • /
  • 2009
  • /
  • 1598-298X(pISSN)
  • /
  • 2384-0749(eISSN)
한국임상수의학회 (The Korean Society of Veterinary Clinics)
권호 표지

시츄견에서 발생한 간경화의 영상 진단

Diagnostic Imaging of Liver Cirrhosis in a Shih-Tzu Dog

  • 최호정 (충남대학교 수의과대학.동물의과학연구소) ;
  • 이기자 (오비히로 축산대학) ;
  • 장진화 (충남대학교 수의과대학.동물의과학연구소) ;
  • 안지영 (충남대학교 수의과대학.동물의과학연구소) ;
  • 오이세 (충남대학교 수의과대학.동물의과학연구소) ;
  • 안세준 (충남대학교 수의과대학.동물의과학연구소) ;
  • 정성목 (충남대학교 수의과대학.동물의과학연구소) ;
  • 박성준 (충남대학교 수의과대학.동물의과학연구소) ;
  • 조성환 (충남대학교 수의과대학.동물의과학연구소) ;
  • 이영원 (충남대학교 수의과대학.동물의과학연구소)
  • Choi, Ho-Jung (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • Lee, Ki-Ja (Department of Clinical Veterinary Science, Obihiro University of Agriculture and Veterinary Medicine) ;
  • Chang, Jin-Hwa (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • An, Ji-Young (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • O, I-Se (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • Ahn, Se-Joon (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • Jeong, Seong-Mok (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • Park, Seong-Jun (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • Cho, Sung-Whan (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University) ;
  • Lee, Young-Won (College of Veterinary Medicine.Research Institute of Veterinary Medicine, Chungnam National University)
  • 발행 : 2009.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

5년령의 암컷 시츄견이 일년 동안의 황달, 복수 등의 증상으로 약물 치료를 받다가 호전을 보이지 않아 내원하였다. 혈액검사 결과 간효소 수치의 상승 및 고글로불린혈증과 저알부민혈증이 확인되었으며, 혈액을 이용한 CAV-1 PCR 검사시 음성임을 확인하였다. 일반 방사선 검사 및 복부 초음파 검사를 통해 간의 크기 감소와 간 실질에서의 저에코성의 다발성 결절 및 복수를 관찰하였고, 복수 검사에서 누출성 복수임을 확인하였다. 복부 CT 검사에서 포도송이 모양으로 조영증강효과를 보이는 다발성 결절이 관찰되었다. 간 생검을 통한 조직병리학적 검사 결과 간 세포의 괴사와 섬유양 세포의 침윤을 확인하였다. 위의 검사 결과를 바탕으로 간경화증으로 진단하였다. 이후 정기적으로 혈액검사, 혈청화학검사, 복부 초음파 검사 및 CT 검사를 실시했다. 내과적 보존적 치료를 실시하였고, 환자는 진단한 지 10개월 후에 사망하였다. 본 증례를 통하여 개에서 간경화증의 CT 영상의 특징을 보고하고자 한다.

A 5-year-old, intact female Shih-Tzu dog was presented with 1 year history of icterus, ascites and anorexia. The serum biochemistry revealed elevated liver enzyme levels. Microhepatica and decreased serosal detail were detected in abdominal radiography. Abdominal ultrasonographic findings included irregular liver margins, multifocal hypoechoic nodules in the liver parenchyma, and ascites. Computed tomography (CT) showed multifocal hypodense nodules with ring-like contrast enhancement. Cytologic and histopathologic examination by liver core biopsy revealed fibrosis. Cirrhosis was diagnosed based on above results. This report focuses on the imaging characteristics of ultrasonography and CT for liver cirrhosis in a dog.

키워드

참고문헌

  1. Biller DS, Kantrowitz B, Miyabayashi T. Ultrasonography of diffuse liver disease. J Vet Intern Med 1992; 6: 71-76 https://doi.org/10.1111/j.1939-1676.1992.tb03154.x
  2. Brancatelli G, Federle MP, Ambrosini R, Lagalla R, Carriero A, Midiri M, Vilgrain V. Cirrhosis: CT and MR imaging evaluation. Eur J Radiol 2007; 61: 57-69 https://doi.org/10.1016/j.ejrad.2006.11.003
  3. Center SA. Chronic hepatitis, cirrhosis, breed-specific hepatopathies, copper storage hepatopathy, suppurative hepatitis, granulomatous hepatitis, and idiopathic hepatic fibrosis. In: Strombeck’s small animal gastroenterology, $3^{rd}$ ed. Philadelphia: W.B.Saunders. 1996: 705-765
  4. Fuentealba C, Guest S, Haywood S, Horney B. Chronic hepatitis: a retrospective study in 34 dogs. Can Vet J 1997; 38: 365-373
  5. Gupta AA, Kim DC, Krinsky GA, Lee VS. CT and MRI of cirrhosis and its mimics. Am J Roentgenol 2004; 183: 1595-1601
  6. Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part 1. Diagnosis and evaluation. Am Fam Physician 2006; 74: 756-762
  7. Hendrix AD. Diagnosis of chronic active hepatitis in a miniature schnauzer. Can Vet J 2004; 45: 765-767
  8. Herdt T. Postabsorptive nutrient utilization. In: Textbook of veterinary physiology, 3rd ed. Philadeiphia: W.B. Saunders. 2002: 304-322
  9. Hoffmann G, van den Ingh TS, Bode P, Rothuizen J. Copperassociated chronic hepatitis in Labrador Retrievers. J Vet Intern Med 2006; 20: 856-861
  10. Ito K, Mitchell DG, Hann HW, Kim Y, Fujita T, Okazaki H. Viral induced cirrhosis: grading of severity using MR imaging. Am J Roentgenol 1999; 173: 591-596
  11. Johnson SE. Chronic hepatic disorders. In: Textbook of veterinary internal medicine, $5^{th}$ ed. Philadelphia: Saunders. 2000: 1298-1325
  12. Larson MM. The liver and spleen. In: Textbook of veterinary diagnostic radiology, 5th ed. St. Louis, Saunders. 2007: 667-692
  13. Leveille CR, Arias IM. Pathophysiology and pharmacologic modulation of hepatic fibrosis. J Vet Intern Med 1993; 7: 73- 84 https://doi.org/10.1111/j.1939-1676.1993.tb03173.x
  14. Mandigers PJ, van den Ingh TS, Spee B, Penning LC, Bode P, Rothuizen J. Chronic hepatitis in Doberman pinschers. Vet Q 2004; 26: 98-106
  15. Nyland TG, Mattoon JS, Herrgesell EJ, Wisner ER. Liver. In: Small animal diagnostic ultrasound, 2nd ed. Philadeiphia: W.B. Saunders. 2002: 93-127
  16. Ong TZ, Tan HJ. Ultrasonography is not reliable in diagnosing liver cirrhosis in clinical practice. Singapore Med J 2003; 44: 293-295
  17. Sevelius E. Diagnosis and prognosis of chronic hepatitis and cirrhosis in dogs. J Small Anim Prac 1995; 36: 521-528 https://doi.org/10.1111/j.1748-5827.1995.tb02801.x
  18. Shih JL, Keating JH, Freeman LM, Webster CR. Chronic hepatitis in Labrador Retrievers: clinical presentation and prognostic factors. J Vet Intern Med 2007; 21: 33-39
  19. Sterczer A, Gaal T, Perge E, Rothuizen J. Chronic hepatitis in the dog-a review. Vet Q 2001; 23: 148-152
  20. Stockhaus C, Van Den Ingh T, Rothuizen J, Teske E. A multistep approach in the cytologic evaluation of liver biopsy samples of dogs with hepatic diseases. Vet Pathol 2004; 41: 461-470 https://doi.org/10.1354/vp.41-5-461
  21. Twedt DC. Cirrhosis: a consequence of chronic liver disease. Vet Clin North Am Small Anim Pract 1985; 15: 151-176
  22. Ward J, Robinson PJ. How to detect hepatocellular carcinoma in cirrhosis. Eur Radiol 2002; 12: 2258-2272
  23. Watson PJ. Chronic hepatitis in dogs: a review of current understanding of the aetiology, progression, and treatment. Vet J 2004; 167: 228-241 https://doi.org/10.1016/S1090-0233(03)00118-7
  24. Willard MD. Inflammatory canine hepatic disease. In: Textbook of veterinary internal medicine, 6th ed. Philadelphia: Elsevier Saunders. 2005: 1442-1447
  25. Van den lngh TS, Van Winkel T, Cullen JM, Charles JA, Desmet VJ. Morphological classification of parenchymal disorders of the canine and feline liver. In: Standards for clinical and histological diagnosis of canine and feline liver disease, $1^{st}$ ed. Philadelphia: Elsevier Saunders. 2006: 85-101