Hello
This is Gooshy an 8 year old Shi tzu with elevated bile acids above 30nmol/L. We are sending to the lab to quantify.
We performed an abdominal US. There are no significant markers other than crystaluria in the bladder. However I did find a vessel near the Lt kidney that seems slightly tortuous and I cannot fully trace it. Doppler shows blood flow away from the transducer. The aorta , cranial mesenteric and Celiac appear normal in that area.
Hello
This is Gooshy an 8 year old Shi tzu with elevated bile acids above 30nmol/L. We are sending to the lab to quantify.
We performed an abdominal US. There are no significant markers other than crystaluria in the bladder. However I did find a vessel near the Lt kidney that seems slightly tortuous and I cannot fully trace it. Doppler shows blood flow away from the transducer. The aorta , cranial mesenteric and Celiac appear normal in that area.
Just wondering if someone could identify the vessel for me. I was wondering if it is possibly a “splenoazygus shunt”. Aorta and CVC appear symmetrical and there is no obvious double aorta sign.
Thanks. Brent
Comments
Just received the bile acids
Just received the bile acids and they are 238 micromol/L. forgot to mention that the liver does look subjectively small as well!
Thanks !Brent
Have been reading some
Have been reading some studies on shunts and I’m going to go out on a limb and say that we are dealing with a spenophrenic shunt. The Ao/CVC and PV ratio are all close to 1.
This dog has to have a shunt with the bile acids that high I believe. Or advanced liver disease.
There is no double aorta, therefore not likely splenoazygous. The study I was reading indicates that splenophrenic shunts encompass 16% of extrac hepatic shunts and course on the left side and communicate with the left side of the CVC at the level of the diaphragm.Could be consistent with my images.
We are going to CT the dog in the near future so hopefully will have answers then but I would love someone’s opinion on the US images.
Thanks. Brent.
Sorry I missed this post for
Sorry I missed this post for some reason.
Surely a shunt and tortuous splenoazygos would be my best guess but needs more views wiht another 3 cm depth and various angles sweeping fromt he portal hilus to the cvc and aorta.
Splenocaval and splenophrenic are tough in my experience to differentiate because they both eventually feed into the cvc and the cvc should be big in both cases because th ephrenic feeds into the cvc. I don;t have agreat technique to differentiate them so if someone does I would love to hear it on this thread. Whereas the azygos shunts bypass the cvc and the cvc/ao ratio are the same. So if you see at the diaphragmatic inlet the ao & cvc are the same volume and the pv is small this would lead to believe there is an azygos shunt entry.
I have a shunt hunt lecture series in 2 parts that I can create a downloadable CE like these ones if anyone thinks its worthy to do so. There are RACE CE credits attached to my lectures on this.
https://sonopath.com/products/downloadable
The double aorta sign would be cranial to the diaphragm in the far field and can be very tough to image but best from right intercostal view usually 11/12 IC pointing into the lung field focusing dorsal to the cvc inlet . See attached image.
Here are a bunch of shunts on US and CT from the archive by using “shunt” keyword in th ebasic search
http://sonopath.com/members/case-studies/search?text=shunt&species=All