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A 7-year-old SF Shih Tzu with a history of a porto-caval PSS shunt that was well managed with medical therapy was presented for evaluation of with lethargy and decreased appetite.
A 7-year-old SF Shih Tzu with a history of a porto-caval PSS shunt that was well managed with medical therapy was presented for evaluation of with lethargy and decreased appetite.
Swollen kidneys.
Bladder calculi.
Microhepatica. Double aorta sign. This is consistent with splenoazygos shunt.
Prominent pancreas.
The liver was persistently subnormal in size. Double aorta was noted in this patient. This is consistent with splenoazygos shunt.
The urinary bladder, trigoneand pelvic urethra presented normal wall thicknesses with anechoic urine and normal tone. Multiple bladder calculi were noted and were non obstructive. The largest calculus measured 0.34 cm. This is likely a biurate given the patient’s history. No evidence of inflammatory or neoplastic changes were noted. The ureters were not visible and therefore considered normal.
The kidneys were both swollen. Medullary echogenicity differed distinctly from that of the cortex and no evidence or dilation could be seen. The capsules were acceptably uniform without dramatic irregularities. Pelvic calculus was noted in the left kidney and measured 0.86 cm. The left kidney measured 5.25 cm. The right kidney measured 4.74 cm with pelvic calculus that measured 0.43 cm.
The pancreas was hypoechoic, mildly enlarged and slightly irregular measuring 1.07 cm.
I strongly recommend surgical consultation at this point in this patient. Given the dropping albumin and low BUN. Medical therapy may not be adequate in this patient for long term management.
Progression of liver shunt
Hepatopathy – cirrhosis, chronic hepatopathy, neoplasia
Pancreas – pancreatitis, neoplasia
