Case Study

Portal vein thrombosis with secondary shunting in a 2 year old M Labrador Retriever post coil shunt surgery

This 2 year old M Labrador Retriever dog. Liver shunt repair with coil July 2015.Recently had developed poor appetite and abdominal ascitis with swelling progressiong along right hind leg; dripping from centesis sites. Protein in urine, chronically. Has been o benazapril, tylosin, omeprazole, spironolactone, furosemide. Hospitalized on hetastarch

CBC/Chem: albumin 1.8, total protein 3.4, calcium 8.3, amylase 1591, PSL 195, USPG 1.025

DX

Chronic hepatic remodeling. Portal vein thrombosis with secondary shunting. This is suggestive for longstanding thrombus with prehepatic portal hypertension. Secondary ascites. Persistently, mild, swollen kidneys.

Image Interpretation

The left kidney was mildly swollen and measured 7.87 cm with mildly increased cortical echogenicity. The liver itself was unremarkable with minor, coarse architecture with slightly increased portal markings. This appears to have adequate size in short axis measuring 7.0 cm. The portal vein revealed a large thrombus that measured 4.0 x1.3 cm. The thrombus appeared to occupy the portal vein completely causing prehepatic portal hypertension. Vascular intervention would be recommended to remove the clot. This appears to be significantly enlarged. Therefore, medical therapy will not likely allow for rapid dissolution. Secondary shunting was noted with irregular vessels likely derived from the region of the pancreaticoduodenal vein. This is consistent with secondary shunting. Areas of remodeling were noted in portions of the liver with expansive nodular changes. A moderate amount of ascites was noted. Regional, echogenic fat was noted throughout the cranial abdomen owing to the ascites and echogenic artifact.

Outcome

Recommend referral to interventional radiologist internal medicine facility for further
management for this complicated
case. If the portal thrombus can be removed then the prehepatic portal hypertension
can be resolved. However, given the chronic changes within the liver it is difficult to
assess whether portal hypertension will persist owing to the chronic hepatic changes.
Very guarded prognosis. Plasma transfusion is recommended in the meantime as well
as full coagulation panel.