A 4-year-old neutered male Yorkshire terrier dog, that had recently been adopted, was presented for evaluation of PU/PD. Urinalysis showed inappropriate SG (1.019). Physical examination, CBC, serum biochemistry, urine culture, abdominal radiographs, and ACTH stimulation test were normal. However, pre-and post-prandial bile acids were elevated at 31.4 and 99.7, respectively
It is likely that the elevated bile acids are due to portal vein hypoplasia in this case, which is a congenital hepatic parenchymal issue and necessitates medical treatment. No further surgical intervention is recommended given that the “double aorta” is not visible. The extrahepatic shunt appears to be completely resolved; the surgical intervention was successful. The minor residual dilation of the shunt is likely not a clinical issue. Portal vein to vena cava and aortic ratios appeared to be normal. The portal vein at the portal hilus prior to the branching appears to be of adequate width. There was no evidence of portal hypertension noted. Repeat liver biopsy could be considered in this case. However, given the prior biopsy, it is likely that primary parenchymal disease is the cause of elevated bile acids. Recommend strict medical treatment and strict diet for this patient.
This ultrasound was performed four months after the initial presentation. Surgical correction of the shunt, and a cystotomy had been performed. No pre-surgical images were provided. The portal vein at the portal hilus prior to branching measured 0.43 cm. The shunt attenuation entry into the portal vein measured 0.3 cm. The portal vein prior to the portal hilus and at the level of the pancreaticoduodenal vein measured 0.6 cm and appeared to be adequate in size. The liver presented adequate size. The right and left liver lobes appeared to be adequate. The medial lobes appeared to be slightly atrophied. Structural changes were insignificant at this time. A residual looping anomalous vessel was noted; however, there was no “double aorta” as noted on the prior sonogram. Therefore, attenuation of the shunt appears to be adequate with residual, minor dilation of the gastroazygos shunt. Given that the “double aorta” has resolved, extrahepatic shunting does not appear to be an issue, even though some minor congestion of the residual portion of the shunt appears to be present. The portal vein to vena cava ratio is approximately 0.85, which is normal.
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Porto-caval shunt, primary portal vein hypoplasia, congenital fibrosis.
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