Case Study

Portosystemic shunt (PSS), splenocaval in a 1 year old MN Sheltland Sheepdog

A 1 year old MN Shetland Sheepdog was presented for the ingestion of chocolate. Physical exam found the patient to be BAR, but was mildly tachycardic. Subcutaneous fluids and activated charcoal were administered. In-house chemistry revealed hyperphosphatemia, hypoglobulinemia, hypoproteinemia and elevated liver enzyme activities. Due to the elevation of the liver enzyme activities and the fact that the dog was considered small for the breed, serum bile acids were performed. Both the pre and post-prandial serum bile acids were markedly elevated.

A 1 year old MN Shetland Sheepdog was presented for the ingestion of chocolate. Physical exam found the patient to be BAR, but was mildly tachycardic. Subcutaneous fluids and activated charcoal were administered. In-house chemistry revealed hyperphosphatemia, hypoglobulinemia, hypoproteinemia and elevated liver enzyme activities. Due to the elevation of the liver enzyme activities and the fact that the dog was considered small for the breed, serum bile acids were performed. Both the pre and post-prandial serum bile acids were markedly elevated.

Sonographic Differential Diagnosis

Extrahepatic shunt likely spleno-caval given the position and straight, short contour.

Image Interpretation

The liver is subnormal in size owing to the minimal visible parenchyma noted from a right intercostal approach. The portal hilus reveals a vertical blue vessel coursing dorsally in an extrahepatic fashion. The color, position and vertical angle of this vessel in the far field does not correspond to normal vascular patterns. The vena cava demonstrates echogenic turbulence in the region of the portal hilus as well as focal dilation suggestive for abnormal tributary flow.

DX

Portosystemic shunt

Outcome

Surgery was recommended to ligate the portosytemic shunt, however, due to financial constraints, the owner elected to relinquish the dog to a shelter.