Case Study

CT – Multiple portosystemic shunts secondary to primary liver disease in a 6 year old FS Chihuahua mix

This 6 year old FS Chihuahua mix has an elevated post prandial bile acids of greater than 300; R/O shunt

DX

The computed tomographic findings are compatible with multiple acquired extrahepatic portosystemic shunts secondary to primary liver disease with portal hypertension.

Image Interpretation

CT of the abdomen –

There is a cluster of multiple abnormal vessels connecting the portal vasculature with the systemic circulation in a medusa head pattern within the retroperitoneal space caudal to the right kidney. The extrahepatic portal vein is undulating in course and uneven in diameter. The hepatic artery presents compensatory enlargement. Severe microhepatica is noted with retracted lobar margins and multiple nodular and cystic changes as well as differential enhancement of the parenchyma. The gallbladder is moderately distended, the gallbladder wall is mildly thickened. The pancreas presents moderate generalized enlargement.

Outcome

The changes of the liver are suggestive for cirrhosis which may be a consequence of chronic hepatitis and fibrosis or primary biliary cirrhosis.
The edema of the gallbladder wall and pancreas are a function of the portal hypertension. Definite diagnosis warrants liver biopsies. Check coagulation panel prior to ultrasound guided Tru cut biopsies or obtain samples surgically.

The overall prognosis is guarded to poor.