Dear All,
I have a 1 year old dobermann patient- with severe hepatic enzyme elevation.
I could see a 3 times bigger v cava-compared to the aorta, a small liver, also turbulence in the v cava.
I think this shunt is extrahepatic- maybe gastro-caval ( i could see with color a huge red vessel caudal to the liver-unfortunatly i don’t have a video with color)
What type of shunt can it be? Any surgical advice? ( I’ve sent the owner to a special surgical center)
Dear All,
I have a 1 year old dobermann patient- with severe hepatic enzyme elevation.
I could see a 3 times bigger v cava-compared to the aorta, a small liver, also turbulence in the v cava.
I think this shunt is extrahepatic- maybe gastro-caval ( i could see with color a huge red vessel caudal to the liver-unfortunatly i don’t have a video with color)
What type of shunt can it be? Any surgical advice? ( I’ve sent the owner to a special surgical center)
Comments
The vena cava does look big
The vena cava does look big but ensure dex domitor wasnt used for sedationas that will dilate the cvc to this level. EHPSS is rare in dobermans they usually get IHPSS but anything is possible. Would need more views here see my 2 part download series on shunt hunting
https://sonopath.com/products/downloadable
and/or consider our eveything lab (https://sonopath.com/educationevents/2019-sonopath-sdep-veterinary-ultrasound-training-educationce-events)
where we go through the shunt hunt and have a shunt hunt table in lab. Otherwise needs CT with contrast which is the gold standard. SDEP protocol 9-14 posiitons cover just about any shunt out there as well.
https://sonopath.com/products/downloadable
also bile acids, blood amonia levels and protein c are helpful of course as alt and ast are all over themap in shunt cases and not sensitive for shunts.
Hope this helps.
SDEP Positions 12, 13 & 14,
SDEP Positions 12, 13 & 14, really set you up to see the portal hilus, and the vasculature as compared to each other (portal, CVC, aorta) to help assess if there is dilation, and so they can be measured adequately. We teach this as a standard view at our SDEP educational events, you can view those upcoming events here 🙂
https://sonopath.com/educationevents/2019-sonopath-sdep-veterinary-ultrasound-training-educationce-events
Also, sedatives can really effect the appearance of vasculature, so scanning without sedatives would give you the truest measurements.