CALCAREOUS NODULES AND DEGENERATIONS OF THE LIVER.
Calcified roundish nodules, in groups, under capsule. Mostly in solipeds. Theories of origin: parasites, microbes, emboli, omphalitis, intestinal disease, biliary obstructions. Calcification of liver with large abdominal aneurisms. Cszoker’s case, Diagnosis and specific treatment impossible.
In the domestic animals in general the liver may become the seat of imperfectly spherical nodules of a white, yellow or brownish white color, varying in size from a millet seed to a pea or hazel nut, and of a gritty consistency and feeling, from the deposition of earthy salts. These may be seen in groups under the proper capsule, the adjacent hepatic tissue being healthy, or atrophied, sclerosed or pigmented. These lesions have been found most abundantly in solipeds.
Pathogenesis. The most varied doctrines have been advanced as to the origin of these lesions. They have been attributed to the previous presence in the liver of linguatula, echinococcus, cœnurus, oxyurus, distoma, and other parasites (Cadeac, Mazanti, Olt, Ostertag, Gripp, Leuckart, Ratz), to glanders, to microbian attacks (Dieckerhoff), to minute embolic infarcts in omphalitis in the foal, or intestinal disease in the adult (Kitt), and to obstructions by the eggs of distomata in the biliary ducts (Galli-Vallerio). It is not improbable that the lesion may be due to any one of these in a specific case, and this may be ascertained by the existence of certain definite features and conditions. Linguatula, echinococcus and cœnurus can only be suspected in districts where these prevail, and a careful examination of the central mass of the nodule should reveal the presence of the indestructible hooklets, as certified for given cases by Olt, Ostertag and Gripp. In case of nematoid worms or distomata, the eggs may possibly be found as in the cases of Villach and Ratz, or the embryos (Mazanti). Or there may be traces of channels formerly hollowed out by the worms in the vicinity of the nodules, as seen by Leuckart. Coincident tumors of the intestinal mucosa from larval nematodes, or aneurism or emboli in the anterior mesenteric artery would corroborate this conclusion. If distomata had started the lesions, the distension of the gall ducts and the thickening of their walls would be likely to indicate their former presence. Glander nodules might be suspected from the absence of a distinct rounded or oval outline, from the lack of a distinct, clear line of demarcation between the nodule and the adjacent liver tissue, and by the manifestation in the periphery of the nodule and around it of free cell proliferation, showing the mode of progression by the invasion of new tissue. If still active, the bacilli should be discoverable in stained scrapings or sections. There should also be distinct indications of the lesions of glanders in the lymph glands of the portal fissure, of the mediastinum, of the submaxillary region and of other parts.
Heiss records an interesting case of general calcification of the horse’s liver, with large aneurism of the abdominal aorta, mesenteric and renal arteries. The liver was thirty-two pounds, puckered on the surface and showed calcic degeneration of the walls of the vessels and hepatic tissue, to such an extent that when the organ was dried it did not add materially to its hardness. Microscopically the diseased centres indicated minute blood clots (thrombi), with fibrinous development and cretifaction. The lesions in this case were attributed to multiple emboli in connection with the aneurism. It might suggest further, microbian infection of both the aneurismal and hepatic vessels. In another case of extensive cretifaction of the horse’s liver reported by Cszoker, the calcified masses tended to assume rounded forms like tubercle, and had a clear glistening surface.
These lesions are mainly interesting in a pathological sense, and unless they are very extensive do not give rise to appreciable symptoms.
Treatment could only be prophylactic and directed to the removal of the special conditions, in which the calcification originated in a given locality.