A 4-year-old SF Pug that had been anorexic for 2 days was presented comatose with miotic pupils. Abnormalities on CBC and serum biochemistry were leukocytosis, neutrophilia, elevated ALT and ALP activity and bile acids (225), and low-normal albumin.
Case Study
03_00447 Noel L PSS
Sonographic Differential Diagnosis
Extrahepatic azygos shunt. Suspect gastroazygos.
Image Interpretation
The liver was subnormal in size, coarse in architecture and revealed increased portal markings. This is consistent with low-grade inflammatory hepatopathy. The vena cava measured 0.78 cm and aorta 0.83 cm. A third vessel that is consistent with azygos double aorta sign was noted and measured 0.6 cm. The azygos shunt was clearly visible through the diaphragm. The vessel appears to be deriving from the left gastric vein coursing in a “C” shape dorsally to the aortic hiatus.
DX
Portosystemic shunt
Outcome
None
Clinical Differential Diagnosis
Hepatic encephalopathy – porto-caval shunt, primary portal vein hypoplasia, acute hepatitis (viral, bacterial, toxins), hepatitic abscessation, Leptospirosis
Organophosphate toxicity
Sampling
None
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Patient Information
Gender :
Female, Spayed
Species :
Canine
Type of Imaging : Ultrasound
Status :
Complete
Clinical Signs
- Anorexia
Images
Blood Chemistry
- Albumin, Low
- Alkaline Phosphatase (SAP), High
- ALT (SGPT), High
- Post-Prandial Bile Acids, High
CBC
- Neutrophils, High
- WBC, High
Clinical Signs
- Anorexia