Hi everyone,

Here it goes:

German Shepherd, 6yo, MC, with history of ascites, peripheral edema, hypoalbuminemia (as low as 1,1-1,9 g/dL), low creatinine and urea, mild elevation of liver enzymes, intermitent diarrhea, for the last 2-3 months. Bile acids are extremely increased (165 fasting [Normal 0-0,8 umol/L], 170 postprandial [Normal 0-30 umol/L]).

My differentials before U/S were severe diffuse hepatic disease (with possible acquire PSShunts), colestasis and congenital portal vasculature anomalies (PSS, PVHypoplasia/microvascular dysplasia).

Hi everyone,

Here it goes:

German Shepherd, 6yo, MC, with history of ascites, peripheral edema, hypoalbuminemia (as low as 1,1-1,9 g/dL), low creatinine and urea, mild elevation of liver enzymes, intermitent diarrhea, for the last 2-3 months. Bile acids are extremely increased (165 fasting [Normal 0-0,8 umol/L], 170 postprandial [Normal 0-30 umol/L]).

My differentials before U/S were severe diffuse hepatic disease (with possible acquire PSShunts), colestasis and congenital portal vasculature anomalies (PSS, PVHypoplasia/microvascular dysplasia).

What I see on U/S:

– No urinary stones, normal kidneys, liver apparently normal to subnormal in size (parenchyma seems OK), mild proeminence of GI mucosa

– No colestasis seen, d-pap OK

– Ascites

– Small PV and big CVC (ratio of 0,47) – consistent with EHPSS

– No turbulence seen in the CVC (excludes portocaval shunt?), no double aorta sign (can’t really eliminate portoazygos shunt, right?), no intrahepatic vascular anomalies seen

– Portal flow was 17cm/s while awakened, while sedated I couldn’t get a good measure (too low, do you think it was affected by the sedation? Maybe portal hypertension here?)

First clip shows the doppler on the CVC demonstrating absence of turbulence, although there is a very little vein that enters the hepatic vein right at the level of the CVC (8-9s of the clip). Could it be the shunt (or one of them)?

Second clip shows Ao entering the diaphragm, with no double ao sign seen

On the third clip you can compare the width of the PV, CVC and Ao

Fourth clip – d-pap, without evidenc of obstruction

What do you think? It’s not colestasis and severe liver disease seems unlikely. EHPSS? PVHypoplasia?

Help is much appreciated, thank you!