Case Study

03_00173 Lady M Portosystemic shunt

A 9-year-old FS Miniature Schnauzer with history of cystic calculi, currently on U/D diet, was presented for routine dental prophylaxis. The urine was dark yellow and had a cloudy appearance and on urinalysis was alkaline and isosthenuria, 1+ proteinuria, 1+ hematuria, leukocyturia, and bacteriuria were present. Urine culture yielded a pure growth of Enterococcus species. Preoperative blood work showed elevated liver enzyme activity, hypoalbuminemia, and severely elevated postprandial bile acids. The patient was treated with Clavamox for 3 weeks.

A 9-year-old FS Miniature Schnauzer with history of cystic calculi, currently on U/D diet, was presented for routine dental prophylaxis. The urine was dark yellow and had a cloudy appearance and on urinalysis was alkaline and isosthenuria, 1+ proteinuria, 1+ hematuria, leukocyturia, and bacteriuria were present. Urine culture yielded a pure growth of Enterococcus species. Preoperative blood work showed elevated liver enzyme activity, hypoalbuminemia, and severely elevated postprandial bile acids. The patient was treated with Clavamox for 3 weeks. On follow up blood chemistry hypoalbuminemia, low albumin/globulin ratio, elevated AST, elevated ALT and activity, and low BUN were evident. Survey abdominal radiographs showed microhepatica.

DX

Portosystemic shunt

Sonographic Differential Diagnosis

Splenoazygos shunt.

Image Interpretation

The liver presented microhepatica with a 1.05 cm wide splenoazygos shunt that was noted in the extra hepatic position. Pre-shunt portal vein measured 0.47 cm. The post shunt portal vein measured 0.25 cm. The vena cava measured 0.65 cm and the aorta measured 0.7 cm. The shunt deviated dorsally prior to the portal hilus and entered into the thorax in the region of the esophageal inlet. No overt structural evidence of inflammatory, infiltrative or regenerative pathology was noted.

Outcome

The patient was recommended for abdominal exploratory and shunt ligation, however, the owners were reluctant to pursue any surgical options. Recheck urinalysis showed no improvement and urine culture was still positive for Enterococcus species. The patient was treated with Clavamox and metronidazole. The patient was eventually euthanized.

Clinical Differential Diagnosis

UTI – resistant bacteria, uroliths, neoplasia, poor owner compliance. Liver disease – congenital (portocaval shunt, micro-vascular dysplasia), chronic liver disease, neoplasia, chronic-active hepatopathy, acute hepatopathy (infectious, trauma, toxins.)