Case report highlights CEUS in rare gallbladder rupture complication
Bottom line
A newly published case report in Veterinary Sciences describes what appears to be the first detailed veterinary imaging account of cholecystohepatic communication secondary to gallbladder rupture in a dog, using contrast-enhanced ultrasonography to map the lesion before surgery. In the report, a 10-year-old Pomeranian had a gallbladder wall defect and a tortuous tubular structure extending into an adjacent, ill-defined hepatic lesion. Contrast-enhanced ultrasonography showed strong enhancement of the tubular structure and weaker, heterogeneous enhancement in the liver lesion, and exploratory surgery confirmed gallbladder rupture with severe adhesions near the suspected communication. The authors argue CEUS helped distinguish the communicating tract from surrounding hepatic change in a complication that’s rarely described in dogs. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For veterinarians, the case adds to a small but growing body of evidence that CEUS can sharpen detection of gallbladder wall necrosis or rupture when conventional ultrasound is equivocal. Earlier canine research found CEUS performed well for identifying gallbladder necrosis or rupture, and multicenter data on gallbladder mucocele cases have shown that standard ultrasonography can miss some ruptures. This report extends that conversation by suggesting CEUS may also help identify unusual fistulous or intrahepatic communications that could affect surgical planning and interpretation of focal liver lesions near the gallbladder. (pubmed.ncbi.nlm.nih.gov)
What to watch: Whether additional case series can show CEUS reliably changes diagnosis, timing of surgery, or operative planning in dogs with suspected gallbladder rupture and adjacent hepatic lesions. (pubmed.ncbi.nlm.nih.gov)
Key facts
- Study type
- Case report
- Journal
- Veterinary Sciences
- Species
- Dog
- Breed
- Pomeranian
- Age
- 10 years
- Condition
- Cholecystohepatic communication secondary to gallbladder rupture
- Imaging method
- Contrast-enhanced ultrasonography
- Key imaging finding
- Gallbladder wall defect with a tortuous tubular structure extending into an adjacent hepatic lesion
- Surgical confirmation
- Exploratory surgery confirmed gallbladder rupture with severe adhesions near the suspected communication
A new case report in Veterinary Sciences highlights an uncommon but clinically important hepatobiliary complication in dogs: cholecystohepatic communication secondary to gallbladder rupture. The report centers on a 10-year-old Pomeranian in which contrast-enhanced ultrasonography identified a gallbladder wall defect plus a tortuous tubular structure tracking into a neighboring hepatic lesion, findings later confirmed at laparotomy. The authors present the case as a rare imaging description of an abnormal communication between the ruptured gallbladder and liver tissue in a dog. (pubmed.ncbi.nlm.nih.gov)
That matters because gallbladder rupture in dogs is already a high-stakes diagnosis, but the imaging picture is not always straightforward. Prior veterinary literature has shown that ultrasonographic signs such as pericholecystic reaction, echogenic peritoneal fluid, and reduced abdominal detail can raise suspicion for rupture, while a 2016 study reported strong diagnostic performance for CEUS in detecting gallbladder necrosis or rupture in dogs. A later multicenter study of 219 dogs with gallbladder mucocele also found that conventional ultrasonography was useful, but not perfect, for identifying rupture. (experts.umn.edu)
In this case, the reported lesion pattern was more unusual than a straightforward biliary rupture. According to the case summary, the dog had a gallbladder wall defect and a tubular structure extending into an ill-defined hepatic lesion. On CEUS, that tubular structure enhanced markedly, while the hepatic lesion enhanced more weakly and heterogeneously, helping separate the suspected communication from adjacent parenchymal change. Surgery then confirmed gallbladder rupture with severe adhesion at the suspected site. Inference: the imaging value here was not simply rupture detection, but lesion characterization in a region where inflammation, abscessation, necrosis, and biliary tract communication could overlap on grayscale ultrasound alone. (pubmed.ncbi.nlm.nih.gov)
There’s only limited directly comparable veterinary literature, which is part of why this case stands out. Reports do exist of other rare fistulous complications from canine gallbladder disease, including cholecystocutaneous fistula and other rupture-associated biliary complications, but detailed imaging descriptions of cholecystohepatic communication in dogs appear sparse. Human literature likewise describes intrahepatic perforation of the gallbladder with liver abscess formation as rare, reinforcing how unusual this pattern is across species. (pmc.ncbi.nlm.nih.gov)
No independent expert reaction specifically to this paper was readily available in the sources reviewed. Still, the broader imaging literature points in the same direction: CEUS can add clinically useful information when biliary wall viability or perforation is uncertain. Prior canine CEUS work found the modality highly accurate for identifying gallbladder necrosis or rupture, and review-style sources in veterinary imaging note CEUS as a complementary tool for gallbladder pathology, especially when standard sonographic findings are ambiguous. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For veterinary professionals, this is less about a single rare Pomeranian case and more about diagnostic mindset. Dogs with suspected gallbladder rupture can deteriorate quickly, and focal hepatic lesions adjacent to the gallbladder may not be primary liver disease at all. This report suggests CEUS may help clinicians better define whether a peri-gallbladder hepatic abnormality represents inflammatory extension, abscess-like change, or a true communicating tract, information that could sharpen triage, client communication with the pet parent, and surgical planning. It also reinforces the need to keep unusual biliary complications on the differential when liver lesions sit immediately adjacent to abnormal gallbladder tissue. (pubmed.ncbi.nlm.nih.gov)
What to watch: The next step is broader validation, ideally through additional case reports or retrospective series comparing grayscale ultrasound, CEUS, CT, surgical findings, and outcomes in dogs with suspected gallbladder rupture. The key question is whether CEUS consistently changes case management, especially in referral settings deciding how urgently to operate and how to interpret atypical hepatic lesions near the gallbladder. (pubmed.ncbi.nlm.nih.gov)