03_00220 Gabby F Portosystemic shunt

Case Study

03_00220 Gabby F Portosystemic shunt

A 7 year old, SF Shih Tzu dog was presented for urolithiasis. The patient has a history of cystotomy for cystic calculi. Urinalysis was within normal limits. Abnormalities on CBC and serum biochemistry were neutrophilia, elevated ALT and elevated ALP activity, and elevated pre-and post-bile acids.

A 7 year old, SF Shih Tzu dog was presented for urolithiasis. The patient has a history of cystotomy for cystic calculi. Urinalysis was within normal limits. Abnormalities on CBC and serum biochemistry were neutrophilia, elevated ALT and elevated ALP activity, and elevated pre-and post-bile acids.

Sonographic Differential Diagnosis

Large looping gastroazygos shunt with pronounced right medial liver lobe.

Image Interpretation

The liver was mild to moderately subnormal in size however a 0.8cm wide looping gastroazygos shunt was noted deriving from the region of the portal vein prior to hilus continuing dorsally bypassing the vena cava and the aorta and entering into the region of azygos vein in a slight tortuous manner near the diaphragmatic inlet. The widest point of this shunt was 1.05cm however it was approximately 0.8cm at the area where it meets the portal vein. The vena cava measured 0.7cm as did the aorta in the same region. The residual portal vein measured 0.35cm. The portal vein prior to the shunt measured 0.7cm. The left lobes of the liver appeared atrophied. The right medial aspect of the liver created a nodular hepatoma type projection of the liver lobe likely secondary to vascular anomaly. Biopsies could be performed at the time of surgery.

DX

Portosystemic shunt

Outcome

None

Comments

No video is available on this patient

Clinical Differential Diagnosis

Liver – porto-caval shunt, microvascular dysplasia, chronic liver failure

Sampling

None

Patient Information

Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Status : Complete

Clinical Signs

  • Dysuria

Images

liver_shunt_gastroazygos_gabby_faraci_7_yr_shihtzufsliver_shunt_gastroazygos_gabby_faraci_7_yr_shihtzufs_2

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • ALT (SGPT), High
  • Post-Prandial Bile Acids, High
  • Pre-Prandial Bile Acids, High

CBC

  • WBC, High

Clinical Signs

  • Dysuria