Case Study

CT – Negative for portosystemic shunt in a 4 month old MN Chihuahua with neurological signs

This 4 month old MN Chihuahua presented with impaired balance, abnormal gait, falling to the side

Physical exam: circling to the left, ataxia, hypermetria of pelvic limbs

CBC/Chem: lymphocytes incr, neutrophils decr, TP 5.1, glucose 127, Phos 7.4

R/O liver shunt

This 4 month old MN Chihuahua presented with impaired balance, abnormal gait, falling to the side

Physical exam: circling to the left, ataxia, hypermetria of pelvic limbs

CBC/Chem: lymphocytes incr, neutrophils decr, TP 5.1, glucose 127, Phos 7.4

R/O liver shunt

DX

The computed tomography of the head and abdomen is within normal limits.

Image Interpretation

CT of the head and abdomen –

head: The computed tomography of the head revelas mild incidental asymmetry between the non-dilated lateral ventricles. The brain parenchyma does not present macromorphologic changes.

abdomen: There is no abnormal vascular connection between the portal vasculature and the systemic circulation. The anatomy of the portal vein tributaries and branching is as expected.

Outcome

Complementary examination of CSF should be considered. If further structural definition of the brain/cervical spine is warranted an MRI may be considered as well.

Macroscopic portosystemic shunting can be ruled out. Non-cirrhotic portal hypertension (former microvascular dysplasia) and ultrasound guided or surgical biopsy of the liver may be considered in case of strong laboratory indication of portosystemic shunting.