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CT – Acquired portosystemic shunt with hepatic fibrosis and portal hypertension , likely infectious, in a 7 year old MN Labrador Retriever

Case Study

CT – Acquired portosystemic shunt with hepatic fibrosis and portal hypertension , likely infectious, in a 7 year old MN Labrador Retriever

This 7 year old MN Labrador Retriever has a history of hypoalbuminemia, low BUN, Lepto ELISA positive and UTI. 

Current CBC/Chem: HCT 38%, bile acids 85, post prandial 100, Albumin 2.2, BUN 7. U/A: bilirubin +1, blood +3, RBC 30-50/hpf

This 7 year old MN Labrador Retriever has a history of hypoalbuminemia, low BUN, Lepto ELISA positive and UTI. 

Current CBC/Chem: HCT 38%, bile acids 85, post prandial 100, Albumin 2.2, BUN 7. U/A: bilirubin +1, blood +3, RBC 30-50/hpf

Image Interpretation

CT of the abdomen – 

The portal vein presents a normal order of intrahepatic branching. However, the individual branches reveal an undulating course. Multiple small tortious vessels emerge from the left gastric and splenic veins and course dorsally in the region medial the left kidney where they end in the region of the left renal vein.  All liver-lobes are small and present with multinodular parenchymal architecture and surface.

DX

The computed tomographic findings are compatible with nodular hepatic fibrosis/cirrhosis, subsequent portal hypertension and acquired portosystemic shunting with multiple extrahepatic portal collaterals

Outcome

With the pertaining history the most likely underlying cause is infectious hepatitis such
as leptospirosis or viral hepatitis with bacterial superinfection. Other possible reasons
would be chronic toxin exposure or copper storage disease – likely with superinfection
too. Primary biliary cirrhosis is a lower potential.
Ultrasound guided Tru cut liver biopsy or surgical biopsies are warranted for further definition. Ultrasound guided Tru-cut biopsies of the liver may be performed with
reasonably low potential for complications under the following conditions: platelet
count > 50*103/μl, <25% prolongation of PT/PTT – less of deviation from normal values acceptable in presence of peritoneal effusion. The intensity of the post procedural patient monitoring needs to be tailored to the degree of deviation from normal reference ranges. The options of causative treatment depend on the underlying disease but are considered limited. Dietetic management should be considered to alleviate the clinical signs. The long term prognosis is guarded to poor.

Patient Information

Patient Name : Tag Kinard/MPI
Gender : Male, Neutered
Species : Canine
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 16_00118

History

  • UTI

Images

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Blood Chemistry

  • Albumin, Low
  • BUN low

Special Testing

  • Leptospirosis Positive

Urinalysi

  • Bilirubin Present
  • Blood Present