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The patient was presented for several days of lethargy, PU/PD, inappetence, but no vomiting. Numerous congenital musculoskeletal abnormalities were apparent. Blood chemistry found globulins 4, ALT 548, all else WNL.
The patient was presented for several days of lethargy, PU/PD, inappetence, but no vomiting. Numerous congenital musculoskeletal abnormalities were apparent. Blood chemistry found globulins 4, ALT 548, all else WNL.
CT evaluation was recommended for surgical planning to evaluate for both the possibility of extrahepatic and intrahepatic shunt. Given the breed and position of the shunt, it would be most consistent with right divisional intrahepatic shunt, yet should be further evaluated by CT. In the meantime, given the confirmed elevated bile acids, medical treatment was recommended for this patient until further intervention could occur. CT evaluation found a single abnormal extrahepatic vessel connecting the portal vasculature with the systemic circulation. The dilated shunt vessel emerged from the portal vein level with the junction of the splenic vein, bypassed the liver dorsally and joined the caudal vena cava at the diaphragm. The extrahepatic portal vein was uneven and small in diameter. The hepatic artery presented compensatory enlargement. The intrahepatic branching of the portal vein was reduced. Second order portal veins could be seen within the hepatic parenchyma. Mild microhepatica was noted. CT was able to identify a congenital extrahepatic porto-phrenic shunt which commonly gets mistaken for an intrahepatic shunt.
The liver demonstrated intrahepatic hypovascularity and overwhelming gallbladder dilation, yet this is not to the level of mucocele formation. Acoustic windows were extremely limited owing to the confirmation of this patient. However, portosystemic shunt was found at the level of the portal hilus, yet appeared to be in the position of a short, right divisional intrahepatic shunt. However, extrahepatic shunt could not be excluded as the visibility was extremely poor and views of the actual anomalous vessel were limited, not allowing for differentiation of intrahepatic or extrahepatic position. The shunt measured 1.2 cm wide.
