Image 1: Small bladder calculi are present with only slight shadowing (+ predictive shunt factor). Image 2: The right kidney does not present any calculi but does reveal and interstitial nephrosis pattern (- predictive factor). Image 3: Mild microhepatica is evident in this long axis view where the diaphragm takes a horizontal angle. Minor Gb distention is present which is normal for a fasted patient. (microhepatica + predictive factor). Image 4: Transverse view of the liver demonstrating only 3.5 cm of hepatic parenchyma further supporting microhepatica. Image 5: Portal hepatis demonstrating a vertical aberrant blue vessel (direction dorsally away from probe; BART= Blue Away Red Toward). The portal vein in the near field prior to the vertical vessel is a 1:1 ratio with the vena cava in the far field. The vena cava maintains a constant volume cranially. Image 6: Following the aberrant blue vessel dorsally we see the horizontal vena cava that does not increase in volume and has constant non turbulent flow. Image 7: Further dorsally toward the diaphragm the vertical blue vessel enters into the diaphragmatic inlet near the vena cava without creating turbulent flow in the cava. Image 8: Long axis oblique view of the vena cava (near field) and the aorta (far field) as they enter into the diaphragm with a 1:1 ratio of vena cava/aorta indicating that the aberrant vessel does not enter into the vena cava since there is no excessive volume. A third anechoic vessel is “sandwiched” cranial to the diaphragm between the vena cava and aorta. Image 9: Still image demonstrating the 1:1 vena cava/aorta ratio and the splenoazygos shunt as it enters the diaphragm creating a “double aorta” effect. Image 10: Color flow evidencing the “double aorta.” Image 11: Splenoazygos shunt (blue) as it enters the diaphragm at the level of the aorta and esophageal inlet. Image 12: Azygos shunt “poster.” Compare these findings with the negative shunt hunt from Case of the month, July 2010. (http://www.sonopath.com/COM_1007.html)