– 5 month male Maltese cross presented for inguinal neuter/deciduous tooth removal
– pre-op bloodwork wnl; premed ace/hydro, induced ket/val, maintained iso
– surgery routine but recovery very, very slow – took 4-5 hours for pet to lift head and sit up (not typically seen)
– abdominal scan: kidneys and urinary bladder normal (no stones), liver small
– portal vein appears to get smaller in diameter moving cranially into the porta hepatis – but I am not sure if I am looking at the portal vein, a branch of the portal vein or another vein altogether?
– 5 month male Maltese cross presented for inguinal neuter/deciduous tooth removal
– pre-op bloodwork wnl; premed ace/hydro, induced ket/val, maintained iso
– surgery routine but recovery very, very slow – took 4-5 hours for pet to lift head and sit up (not typically seen)
– abdominal scan: kidneys and urinary bladder normal (no stones), liver small
– portal vein appears to get smaller in diameter moving cranially into the porta hepatis – but I am not sure if I am looking at the portal vein, a branch of the portal vein or another vein altogether?
– suspicious connection between the PV and CVC – shunt?
Have discussed pre/post bile acids with the owner as a next step.
Comments
Looks like your are gettign
Looks like your are gettign color bleeding here without a true turbulence pattern in the cvc. Your pv cvc ratio is normal at what you have indicated as a shunt in the third still image. But in your first image there is a differential normal pv then small pv. In that position I would be concerned for a gastrocaval or gastroazygos shunt as that differential is furtehr cranial than you would find with a splenocaval or splenoazygos shunt. I would scan again and look for a looping shunt at the pylorus. Also scan further caudally just cranial to th eright kidney and push in to see the PV then let up lightly and use micromaneuvers to check for spleno caval or splenoazygos. Of course the BA should be well over 100. See these ones on the basic search on shunts:
http://sonopath.com/members/case-studies/search?text=shunt&species=All
Looks like your are gettign
Looks like your are gettign color bleeding here without a true turbulence pattern in the cvc. Your pv cvc ratio is normal at what you have indicated as a shunt in the third still image. But in your first image there is a differential normal pv then small pv. In that position I would be concerned for a gastrocaval or gastroazygos shunt as that differential is furtehr cranial than you would find with a splenocaval or splenoazygos shunt. I would scan again and look for a looping shunt at the pylorus. Also scan further caudally just cranial to th eright kidney and push in to see the PV then let up lightly and use micromaneuvers to check for spleno caval or splenoazygos. Of course the BA should be well over 100. See these ones on the basic search on shunts:
http://sonopath.com/members/case-studies/search?text=shunt&species=All
Thanks for the tips – will
Thanks for the tips – will see what BA’s are and go from there.
Thanks for the tips – will
Thanks for the tips – will see what BA’s are and go from there.