A telemed client on a shunt hunt in a terrier with a BA of 60 was confused on why I didnt call this curved vessel an EHPSS. I thought the explanation may help as this is a common error especially with microhepoatica all the key vessel entries such as the gdv(pdv) and splenic vein connections to the pv are pulled cranially ( see diagram by my tech Kelly Vazquez).

A telemed client on a shunt hunt in a terrier with a BA of 60 was confused on why I didnt call this curved vessel an EHPSS. I thought the explanation may help as this is a common error especially with microhepoatica all the key vessel entries such as the gdv(pdv) and splenic vein connections to the pv are pulled cranially ( see diagram by my tech Kelly Vazquez).

So you have to use positions 12 and 13 SDEP more so than position 11 or 14 to image the portal hilus adequately cranially where the pv branches into the liver to get a true pv/cvc ratio.

Here was my explanation:

“The curved vessel you think is a shunt is an oblique angle of the pancreatoduodenal vein to gdv entering the portal vein. EHPSS have a small pv cvc ratio at the hilus after the GDV (confluent of the pancreatoduodenal vein) entry which is the last vein entry to the pv prior to the hilus. The liver is somewhat small (likely from portal hypoplasia/mv dysplasia)which brings this connection further cranial than normal. Also EHPSS are below the pv on the screen or dorsal to it. Your vessel is above the PV or ventral to it which is the gdv/pdv.