Case Study

Portosystemic shunt in a 3 year old Yorkshire Terrier with micro hepatica and renomegaly

A 3-year-old SF Yorkshire terrier was presented for evaluation of lethargy, anorexia, and intermittent polydipsia. The only abnormality on urinalysis was low SG (1.018). CBC was within reference range. Abnormalities on serum biochemistry were low BUN and severely elevated ALT activity (>1000).

Sonographic Differential Diagnosis

Splenocaval (likely) portosystemic vascular anomaly. There is severe secondary microhepatica and renomegaly.

Image Interpretation

Liver was severely reduced in size, with normal curvilinear shape and echogenicity. No focal lesions are appreciated. The gall bladder is clean and of normal size and shape. PV:Ao = 0.5 –> A portal vein/aortic ratio of >0.8 is strongly indicative of the absence of a PSS. -Cote, Etienne (2011-03-16). Clinical Veterinary Advisor: Dogs and Cats (Kindle Location 89009). Elsevier Health. Kindle Edition. A large s-shaped vessel is noted connecting the portal vein dorsally to vena cava consistent with a portosystemic vascular anomaly (splenocaval). The shunt measures 5.9mm at the proximal aspect and 3.2mm at caval end.

DX

Portosystemic shunt

Comments

Case courtesy of Marty Henderson, DVM – SonoVet, Inc.

Clinical Differential Diagnosis

Acute hepatopathy (viral, bacterial, toxins), porto-caval shunt, primary portal vein hypoplasia, chronic active hepatopathy, fibrosis, granulomatous disease