Surrendered for urinary incontinence. ALT 452, BUN 4, HCT 50 but MCV low. No crystals on UA; pH 8 w/ SpG 1.005-1.025 at different times. No neurologic symptoms specifically noted.
Thought I found an area where PV was tortuous extrahepatically, but could not document a shunt on color doppler (lots of sparkles and wondering if due to artifact from overlying gas (patient not fully fasted). Liver smallish and hyperechoic with what I thought were attenuated portal markings. Both kidneys are plump with poor C-M distinction and some mineralization, no pyelectasia. Some hyperechoic non shadowing debris suspended along dorsal urinary bladder floor.
rDVM did urine bile acid:creatinine which is pending. We’ve discussed that she will likely need to do pre and post prandial bile acids. Also concerned may be microvascular dysplasia or another primary hepatopathy. If bile acids high, I will ask her to 12+ hour fast and then sedate with propofol
Comments
The third video is
The third video is interesting as no vessel should be tortuous like that and the contour and shape would suggest splenocaval or splenoazygos shunt. If you can follow that vessal dorsally down the screen and see if it flows into the CVC or if it bypasses it. If its a shunt then the post prandial BA should be well over 80.
Hi Eric, I repeated the scan
Hi Eric, I repeated the scan today and think I am seeing a shunt off of the tortuous vessel. It is not causing as much turbulence in the CVC on color flow as I would expect. I’ve edited my original post and replaced most of the images with ones captured to day including the porta hepatis. The tortuous vessel is near the stomach/after portal vein and the shunting vessel heads towards the left liver. Appreciate any additional thoughts.
VIDEO 3 looks like a
VIDEO 3 looks like a splenocaval or splenoazygos shunt.
Video 5 is the celiac or hepatic artery and its red…so wrong direction.. all main parts of shunts are blue as flow is away from the transducer as they decourse dorsally down the screen.
Thank you Eric. Very
Thank you Eric. Very helpful. Just thought I had confirmed CVC as to what video 5 was dumping in to.