Ultrasonographic findings in a cow with vascular hamartoma of the liver: case report
© Braun et al; licensee BioMed Central Ltd. 2011
Received: 20 March 2011
Accepted: 4 September 2011
Published: 4 September 2011
This is the first description of the ultrasonographic findings in a cow with vascular hamartoma of the liver.
Ultrasonographic examination of a six-year-old Swiss Braunvieh cow revealed an excessive number of hypoechogenic blood vessels in the liver parenchyma and a thrombus in the right hepatic vein. The activities of the liver enzymes and the concentration of bilirubin were within the reference ranges. At postmortem examination, a poorly delineated, non-encapsulated lesion, measuring approximately 10 cm × 10 cm in diameter, was found in the right liver lobe. The cut surface of the lesion was sponge-like and contained extremely dilated blood vessels, one of which was occluded with a branching red thrombus. A vascular hamartoma of the liver with thrombosis was diagnosed based on the histological findings.
To our knowledge, this is the first description of the ultrasonographic findings of vascular hamartoma of the liver in a cow. Hamartoma should be considered part of the differential diagnosis in cows with an abnormally large number of blood vessels in the liver parenchyma. This case report broadens the spectrum of liver diseases and ultrasonographic findings of the liver in cattle.
The term hamartoma refers to focal disordered overgrowth of mature tissue that is indigenous to the organ involved . Vascular hamartomas may occur at any site in the body. Most hamartomas are present at birth and their growth is coordinated with that of the surrounding tissue. Mesenchymal (largely vascular) hamartomas of the human liver, though rare, are a distinct clinicopathological entity, occurring primarily in infants and young children and seldom in adults [2–6]. Hamartomas in cattle have also been described primarily in calves, young animals and rarely in adults. In calves, hamartoma of the bile ducts , lungs , vagina , testicle , smooth muscle of the abomasum  and gingiva [12–15] has been reported. In adult cattle, hamartoma of the liver , ovary  and heart  has been described. Hamartoma of the liver in human fetuses and children manifests clinically as abdominal enlargement. However, in cattle, hamartoma has not been diagnosed in vivo and is usually an incidental finding at necropsy or slaughter . The goal of this case report was to describe the ultrasonographic findings in a six-year-old Swiss Braunvieh cow with hamartoma of the liver.
Hamartoma of the liver is rare in mammals. In cattle, there is only one report, which described the postmortem diagnosis of liver hamartoma in eight healthy slaughter cattle . Liver hamartoma has been reported in an equine fetus  and three dogs [20–22]. In contrast to human beings, liver hamartoma in cattle does not appear to be clinically significant. The bovine cases described were incidental findings during post-slaughter inspection . In the present case report, the liver hamartoma was also a coincidental finding during work-up of a regurgitation problem, in which routine ultrasonography revealed a liver lesion. The ultrasonographic appearance of the lesion was confusing because it did not resemble anything we had seen in the past 20 years. However, the findings were similar to multicystic lesions described for liver hamartoma in human medicine [2, 4–6]. In our case, it was not clear initially whether the dilated vessels were blood vessels or bile ducts. The differential diagnosis included dilatation of hepatic vasculature attributable to right-sided cardiac insufficiency or thrombosis of the caudal vena cava; cholestasis and neoplasia were other possible rule-outs. Right ventricular heart failure was ruled out because the cow had a normal heart rate and no jugular distension. The venous thrombus suggested thrombosis of the caudal vena cava because septic thrombi have been described in the caudal vena cava  as well as in the hepatic veins . Thrombosis of the caudal vena cava was ruled out because in our experience, this vein is oval to circular in cross-section when dilated . In addition, the pattern of multiple dilated vessels had not been seen previously in cases with thrombosis of the caudal vena cava. The red thrombus found in our patient was likely attributable to poor venous blood flow or blood stasis. Its red colour was due to a high proportion of erythrocytes and relatively few platelets . Similar thrombi were found in four of eight hamartomas in cattle . The ascites seen in our patient was due to portal hypertension . The ultrasonographic findings of the liver were uncharacteristic of cholestasis  or liver tumours . The activities of liver enzymes and concentration of bilirubin were also normal, which did not support a diagnosis of cholestasis or liver tumour. A biopsy may have provided an in-vivo diagnosis, but euthanasia was elected for other reasons. However, it is questionable whether biopsy is indicated in a suspected vascular tumor. The findings of this case report provide important reference data for the diagnosis of liver hamartoma in cattle.
In cows with a greater than normal number of hypoechogenic blood vessels in the liver parenchyma, the differential diagnosis should include vascular hamartoma. To our knowledge, this is the first description of the ultrasonographic findings of vascular hamartoma of the liver in cattle. Vascular hamartoma of the liver must be part of the diffferential diagnosis in cows with dilated liver vessels, normal activities of liver enzymes and a normal concentration of bilirubin. The case reported broadens the spectrum of liver diseases and the ultrasonographic findings of the liver in cattle.
Consent was obtained from the owner of the cow for publication of this case report and any accompanying images.
The authors thank Dr Markus Stöckli, practicing veterinarian, for referring the cow to our clinic, the technicians of the Medical Laboratory for the haematological and biochemical analyses and the animal assistants for looking after the cow.
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