Hazel is a 1 y 5 m FS Labradoodle who had an episode of collapse with pale mm, weak and shocky about 1 week ago. Was treated with IV fluids IV dexamethasone, benadryl and cerenia. She responded to treatment but not completely back to herself.
ACTH stim was done at time of episode and had a blunted response pre value <.2 and post 3.
Initial chem showed low K+, low albumin, low total protein and low cholesterol and mild increased ALT 197 and ALP 147.
Recheck of the chemistry showed only the ALT and ALP still mildly elevated.
Hazel is a 1 y 5 m FS Labradoodle who had an episode of collapse with pale mm, weak and shocky about 1 week ago. Was treated with IV fluids IV dexamethasone, benadryl and cerenia. She responded to treatment but not completely back to herself.
ACTH stim was done at time of episode and had a blunted response pre value <.2 and post 3.
Initial chem showed low K+, low albumin, low total protein and low cholesterol and mild increased ALT 197 and ALP 147.
Recheck of the chemistry showed only the ALT and ALP still mildly elevated.
Bile acid tolerance shows elevation with pre of 59.4 and post 90.3. Normal size liver on radiographs
Wondering about a portal vein hypoplasia, intravascular shunt or toxin/insult to liver.
The scan did not support an EHPSS but I am not sure if these images suggest an intrahepatic. Would appreciate some extra input.
Thank you!
Comments
The contour of the
The contour of the intrahepatic vein looks odd but can’t call it a shunt. Would have to approach it from the high right intercostal approach trying to image the conncetion between the primary hepatic veins and the CVC. this is the best view for IH shunts. The hx would suggest IH shunt though and the breed would most likely have IH shunt as opposed to EHPSS or MVD/portal hypoplasia.
See this example.
https://sonopath.com/members/case-studies/cases/0300517-sandy-m-intrahepatic-pss
Ct of course is the gold standard for shunts is US can’t define it.
Here are some CT shunts from the archive as well
https://sonopath.com/members/case-studies/cases/0300517-sandy-m-intrahepatic-pss
Thanks. I was in an
Thanks. I was in an intercostal view but guess not high enough.
If there were truly an intrahepatic shunt present, would the liver be expected to be small like EHPSS? I would expect so but in this dog the liver is normal in size both subjectively on ultrasound and on radiographs. If the bile acids weren’t high I would lean away from it but the internist was suspicous of a shunt.
Thanks again!
Take a look at our research
Take a look at our research on shunts from the sonoographic perspective form ECVIM in Tolousse.
https://sonopath.com/resources/research-publications
The probabilioty of having a shunt depends also on the presence of ub stones, renal stones and swelling, microhepatica… If those things arent present the probability of a macroscopic shunt drops rapidly.
That being said right divisional IH shunt is the most difficult shunt to detect sonographically and need high right IC view position 12-13 sdep abdomen. See products in this link and the diagram attached form the book I can never finish 🙁
https://sonopath.com/products/downloadable
IH shunts can occasionally have near normal to normal liver size though. I would chase this higher IC view and/or defer to CT with contrast.
Thanks. I am going to rescan
Thanks. I am going to rescan this dog next week.