Case Study

03_00539 Dayze H PSS

An 8-month-old Maltese was presented for evaluation of pre-and post-prandial bile acids 124 and 194, respectively.

Sonographic Differential Diagnosis

Looping gastrocaval shunt with minor microhepatica.
Concurrent portal vein hypoplasia was also possible.
Recommend surgical consultation can be considered; however, medical management may also be adequate in this patient. Recommend reassessment of the bile acids after 4-6 weeks of medical management. If bile acid reduction is not significantly achieved then surgical approach would be recommended. This patient cannot undergo any acute phase disease in its lifetime regardless of whether medical or surgical approaches are taken in this case. No current bladder stones or renal calculi were noted at this time. However, these may develop. Therefore, if surgery is to occur, a rapid sonogram is recommended at the time of surgery or direct palpation of the bladder to assess if any ammonium biurate calculi form.

Image Interpretation

The vena cava at the level of the portal hilus measured 0.84 cm. The portal vein at branching measured 0.3 cm. The portal vein prior to the pancreaticoduodenal vein measured 0.47 cm. The initial portion of the gastrocaval shunt measured 0.47 cm in the region of the portal vein. The medial lobes of the liver appeared slightly atrophied. However, the general parenchyma appeared adequate in size. Width at short axis measured approximately 2.0 cm. The gallbladder was unremarkable. A looping gastrocaval shunt was noted in this patient in which a flattened “question mark” type contour was noted after tortuous anomalous vessel deriving from the region of the left gastric vein. This decoursed caudally and entered into the vena cava. The entrance into the vena cava of the shunt measured approximately 0.5 cm. The maximum width of the shunt measured approximately 0.8 cm.