Hi, I would apprecite your interpretation of these clips:
– 5year old Male intact chihuahua cross (5kg, not too small) presented for hematuria a few weeks back. A partial urinary tract scan showed lithiasis in bladder and kidneys. Cystotomy performed and 100% urate stones retrieved. Currently asymptomatic but history of a potential seizure episode 1 year ago. Apparently the smallest of the litter. A full scan for PSS hunt performed today.
-US: lithiasis in kidneys. Bladder has mobile sediment and some sand in prostatic urethra. Liver appears small.
Hi, I would apprecite your interpretation of these clips:
– 5year old Male intact chihuahua cross (5kg, not too small) presented for hematuria a few weeks back. A partial urinary tract scan showed lithiasis in bladder and kidneys. Cystotomy performed and 100% urate stones retrieved. Currently asymptomatic but history of a potential seizure episode 1 year ago. Apparently the smallest of the litter. A full scan for PSS hunt performed today.
-US: lithiasis in kidneys. Bladder has mobile sediment and some sand in prostatic urethra. Liver appears small.
-Porta/cava system: there appears to be a vessel from porto-splenic vein to caudal vena cava . There appears to be a decreased portal vein diameter proximal to this vessel. This vessel is seen in sagittal views, right caudally to pyloric region and it is relatively of small calibre (it appears to go dorsally into CdVC-blue on doppler). Now, on trasnverse views (and also sagittal) I can also see a tortuous large vessel which I think it is abnormal but I am not clear where it goes. I see what it seems to me like “too many large vessels”…the large (0.64cm) one it appears to be spleno-caval (may be spleno azygos), the small one…it appears to drain in cava…so, I wonder whether this is a gastrocaval shunt? if so…what is the large vessel?
– What else would be the next recommendation in order to determine whether or which surgical approach is indicated? Likely this might be refered to a surgeon specialist to consider.
-Considering patient is currently asymptomatic appart from the urate formation (pretty quick after cystotomy a few weeks back), would medical treatment improve the urate formation?
-Thanks for any input and I apologize for the extra videos. I do feel frustrated with shunts…so I really hope they are diagnostic for you.
Comments
The ? shaped shunt is usually
The ? shaped shunt is usually the gastric shunt deriving from the left gastric vein. Splenic shunts are short and the most frequent but also easier to miss. Gastrocavals and gastroazygos shunts are follow the colorful waves ventrally (red) first then dorsally (blue) whereas splenocavals are nearly all blue as they head dorsally in a short and direct manner. See my annotation from your first ad 4 video screen shots. I could help more with a full evaluation via telemed but this is diagnostic for PSS with patterns consistent with gastrocaval given the conical enlarged cvc… if you follow that cvc caudally and do some probe light gymnastics you will likely connect the shunt to it.
Gastrophrenics do this as well as the sort of blend into the cvc so tough to tell the difference between a phrenic and caval entry because the phrenic enters the cava… phrenic vs cava is a new denomination but i honestly dont bother to try to distinguish to that level… it just needs and ameroid med tx and loiver bx to see if portal hypoplasia is present as well. Cool case beauty images!
Here’s some of our reserach on US detection of shunts
ECVIM 2010
http://sonopath.com/resources/research-publications
and a gastrocaval case to compare with a smaller loop
http://sonopath.com/members/case-studies/cases/gastric-portocaval-shunt-and-microvascular-dysplasia-mvd-4-year-old-mn-ma
As usual extremely helpful
As usual extremely helpful comments here. I’m glad these are “quite” diagnostic videos. I think I do see the connection to CVC in some of my clips on transverse view, I think I will send you this as a telemed case because I still have a few questions and I think you need more clips for full assessment. I will email you privately.
In general, I find it difficult to mentally visualize how the normal vessels run or appear in the scan with the exception of the splenic vein, portal vein, CVC and aorta (and its immediate branches). Basically, I need a schematic/drawing approach to the anatomy. I know the theory but I need some pictures…Like…I cant quite figure how the phrenic vein, gastric vein even the azygos vein run (and appear in the scan monitor) in a normal patient…So like in this case, I know there is a shunting vessel just not quite sure the percourse…Any advice on how to get better at vascular recognition appart from Anatomy books? (which I am already using…)
thanks again for your help.
OK so its tough to teach
OK so its tough to teach shunts in a post as its usually a series of 4 hour lectures but here are some schematics that I created with my tech Kelly that will be part of the shunt hunt chapter in the big clinical sonography book that I’ve been working on for 7 years now…Clinical Approach to Sonographic Pathology. Its a beast so still about 20% more to go..
https://sonopath.com/products/clinical-approach-veterinary-sonographic-pathology-small-animal-and-exotics-editing
But see if these schematics on the different types of shunts help out starting with the normal portal hilus. Again these are general depictions as for example your gastrocaval is a big loop on the ? shape whereas others are smaller loops but these should give the idea. Note that the literature even in the WASAVA liver book changes the vessel names here and there but I tried to simplify with these from the sonographers perspective.
Please I only ask that these do not get spread around outside of member use on the forum as this will be published material and Kelly, my tech and graphic designer, is Sicilian so she will be very upset if her work gets moved around before the book is published:)
Dear Eric…I am extremely
Dear Eric…I am extremely grateful for this kind answer. This is probably what I have been looking for all this time. I have already sent all my clips for sonopod cast telemed…it is the first time I have done it so im not entirely sure whether what ive sent is ok or not. I know about the SDEP protocol. in this particular case, I have not sent the full abdo report cause i am focused on trying to identify this particular shunt but in general, I do follow the SDEP protocol…)I need to replay both abdo and cardio again and refresh some things, i think).
With regard to sharing of these images, rest assured I will respect your request. It is very kind of you sharing them for teaching purposes. Kelly can be sure her work is safe. I am partly Italian, partly latina so I would react pretty much in the same way!
On a very different subject, for a few months now it appears like the emails for the comments in the posts im subcribed to do not ever arrive (neither to junk mail), any idea on why would this be?
Thanks again and very much appreciate it.
Checking with IT on the alert
Checking with IT on the alert system.
You are welcome hiope the drawings help.
IT resoilved the issue FYI so
IT resoilved the issue FYI so you should get th eemail notifications it was disabled for some reason on your acct.
I was just going to post
I was just going to post under “What are your most difficult views as a songrapher.” for the same exact concerns of vascular recognition. Thank you for this post!