This 4 year old FS Maltese mix presented with episodes of vomiting; bile acids elevated, mild renal changes noted on ultrasound 3 months prior. R/O portosystemic shunt
This 4 year old FS Maltese mix presented with episodes of vomiting; bile acids elevated, mild renal changes noted on ultrasound 3 months prior. R/O portosystemic shunt
CT of the 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. No microhepatica was noted. Both kidneys present within normal limits for size, shape and excretion behaviour.
Consider primary hepatic disease or non-cirrhotic portal hypertension as differential diagnoses. Ultrasound guided or surgical liver biopsies may be enforced for further definition in case of strong indication of underlying hepatic disease/portosystemic shunting.
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.
