Hepatic venous gas (I think)

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Hepatic venous gas (I think)

  • 12 yo MN lab mix, 80 lbs
  • No clinical signs
  • Mildly elevated but increasing liver values (ALP 398, ALT 180, GGT slightly elevated, normal bili).
  • U/s shows slightly hyperechoic liver. After sedation, noted hepatic air bubbles. I thought at first it was biliary sludge but then saw them moving rapidly through the veins.
  • I suspect these bubbles are in the hepatic veins as one video shows one entering the vena cava.
  • U/S also shows splenic myelolipomas and one capsule-distorting splenic mass. No GI disease. Lymph nodes normal.

    • 12 yo MN lab mix, 80 lbs
    • No clinical signs
    • Mildly elevated but increasing liver values (ALP 398, ALT 180, GGT slightly elevated, normal bili).
    • U/s shows slightly hyperechoic liver. After sedation, noted hepatic air bubbles. I thought at first it was biliary sludge but then saw them moving rapidly through the veins.
    • I suspect these bubbles are in the hepatic veins as one video shows one entering the vena cava.
    • U/S also shows splenic myelolipomas and one capsule-distorting splenic mass. No GI disease. Lymph nodes normal.
    • Both splenic mass and liver were FNA’d. The bubbles were seen prior to FNA but post sedation.
    • From my reading, it seems that ddx include necrotizing colitis/gastroenteritis or iatrogenic (usually major interventions like femoral vein catheterization in humans?). This dog has no clinical signs (although diarrhea if he gets into the garbage) and feels fine, good energy.
    • Questions: in the absense of clinical signs, do I worry? Could this be due to air injected into the veins post sedation? (I didn’t see the bubbles until the dog was sedated, but I don’t know if that’s just because he was tense and panting prior to sedation). What should the plan be?

Comments

DrMac
February 14, 2020 at 9:51 pm -

Weird…I dont think I’ve

Weird…I dont think I’ve seen that before. At first I was thinking they were small calculi in the biliary tree but they do look like they are in the hepatic vasculature. I do think they could be hepatic venous bubbles. Unless the dog has clinical signs like fever or sepsis or something, or a hepatic abscess we arent seeing, I wouldnt worry about them per se. It would be good to see if they resolve, which if air, will dissolve. Maybe others have other ideas. 

 

Liz
February 17, 2020 at 9:41 pm -

That’s what I thought at

That’s what I thought at first too – biliary sludge – but they are just moving too fast and the color doppler picks up in the spaces where they are moving. I can follow one into the vena cava.

I posted on a mobile u/s facebook groups as well, and other mobile sonographers reported that they have seen similar after saphenous sedation, so I guess that’s what it is. I’ve asked to rescan the dog this week to see if they are gone. I’ll update as I can.

EL
February 16, 2020 at 6:05 pm -

Wow Liz leave it to you to

Wow Liz leave it to you to come up with something odd like this:) Venous air bubble injection makes the most sense here since no clinical signs and would not be there on a recheck i would think.

Liz
February 17, 2020 at 9:42 pm -

Haha, right? 

Haha, right? 

Liz
February 17, 2020 at 9:52 pm -

Here’s an interesting

Here’s an interesting retrospective study in humans: https://www.ncbi.nlm.nih.gov/pubmed/21705895

Liz
February 17, 2020 at 9:56 pm -

Just realized I mislabeled

Just realized I mislabeled the thumbnail – not a portal vein, a hepatic vein.

EL
February 22, 2020 at 10:09 pm -

Cool  thanks for the article

Cool  thanks for the article Liz!

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