Case Study

03-00401 Charlie W PSS—-NEEDS EL TO CAPTION AND CHECK SI/SDX—-

An 8-month-old Miniature Schnauzer was presented for evaluation of lethargy and polyuria. Urinalysis showed no significant abnormalities. Abnormalities on CBC and serum biochemistry were leukocytosis, lymphocytosis, severely elevated bile acids (220), and elevated ALT and AST activity.

Sonographic Differential Diagnosis

Extrahepatic portosystemic shunt. This is consistent with gastroazygos or gastrocaval shunt.
Concurrent bladder calculi. Chronic cystitis pattern.
Swollen kidneys.
Recommend cystotomy with stone removal and lavage, stone culture or bladder wall culture. Ameroid constrictor placement with liver biopsy would be indicated. The ameroid should be prepared for an anomalous vessel that measured approximately 0.8 cm as it derives from the portal vein.

Image Interpretation

The liver was subnormal in size and mildly coarse in architecture. Measurement in transverse measured 1.43 cm. This is consistent with significant microhepatica. The vena cava measured 0.57 cm, aorta 0.69 cm. The portal vein entered into the portal hilus at normal size; however, just before the bifurcation within the liver an anomalous vessel with a question mark form, consistent with gastrocaval or gastroazygos shunt was noted. This was extrahepatic in position. Given that the vena cava and aorta are normal in size, this is likely a gastroazygos shunt; however, a deep cranial entrance into the vena cava could not be ruled out.
The urinary bladder presented a large amount of calculi that embedded into the urethra. Chronic cystitis pattern was also noted. Accumulation of sand and small calculi measured approximately 2.5 cm.
The kidneys were mildly swollen. The right kidney measured 5.25 cm. The left kidney measured 4.95 cm.

DX

Portosystemic shunt

Outcome

None

Clinical Differential Diagnosis

Congenital liver defect – porto-caval shunt, primary portal vein hypoplasia, fibrosis
Acute hepatopathy – viral, bacterial, toxins

Sampling

None