Case Study

CT – Double congenital extra hepatic portosystemic shunt in a 7 month old M Scottish Terrier with elevated bile acids

This 7 month old M Scottish Terrier dog presented with dull coat, pale conjunctiva, lethargy.Has a history of elevated bile acids.

CBC: WBC 20.1, HCT 36.1, Seg Neutrophils 79, Lymphocytes 11

Chemistry: total protein 4.5, albumin 1.6, ALKP 262. 6/7/2016 bile acids 35, bile acids post 262.4 ; 2/12/2016 Bile acids 1.6, Bile acids 2 hr. post 78. WBC at this time was 24.7, HCT 24.3

Urine Analysis: Sp G 1.025, pH 5.5, trace protein, Neg for blood, color pale yellow, ++ cocci, no crystals, no WBC, no RBC

This 7 month old M Scottish Terrier dog presented with dull coat, pale conjunctiva, lethargy.Has a history of elevated bile acids.

CBC: WBC 20.1, HCT 36.1, Seg Neutrophils 79, Lymphocytes 11

Chemistry: total protein 4.5, albumin 1.6, ALKP 262. 6/7/2016 bile acids 35, bile acids post 262.4 ; 2/12/2016 Bile acids 1.6, Bile acids 2 hr. post 78. WBC at this time was 24.7, HCT 24.3

Urine Analysis: Sp G 1.025, pH 5.5, trace protein, Neg for blood, color pale yellow, ++ cocci, no crystals, no WBC, no RBC

Image Interpretation

CT of the abdomen, plain and post contrast –

Portosystemic collateral circulation with two extrahepatic shunt vessels with seperate openings into the caudal vena cava is noted: One abnormally dilated shunt vessel is emerging from the splenic vein and enters the caudal vena cava from the left side caudal to the liver level with the cranial pole of the right kidney. The second vessel emerges from the right gastric vein and loops into the caudal vena cava with a ventral opening at the same level. Cranial to the shunts the diameter of the portal vein is reduced significantly. No second order intrahepatic portal vein branches are recognized. There is microhepatica. The gall bladder is large. Mild symmetric bilateral renomegaly and adrenomelagy is noted. A small rightsided non-obstructive renal calculus is seen.

DX

double congenital extrahepatic portosystemic vascular anomaly with shunt vessels emerging from the splenic and right gastric veins.

Outcome

Especially integrating the clinical signs surgical or interventional shunt attenuation is indicated. Both shunts open into the caudal vena cava at the same level caudal to the liver.