Shunt or no shunt

Blacky, about 1-year-old male neutered persian cross was presented with the complain of lethargy and anorexia of few days duration. Physical examination showed pyrexia of 39.9. Blood test showed mildly elevated ALT. The cat’s fever didn’t respond to symptomatic treatment, though the cat became BAR with the fluid therapy and antibiotics and meloxicam. I did the abdominal US today to find the cause of fever. Liver was mildly hypoechoic with normal CBD. I found one tortuous blood vessel, probably arising from the right portal vein and emptying in the vena cava. Is it the intrahepatic PSS. Also need ur input on the echogenicity of the liver. I do get confused when checking the echogenicity of the organs. Any tips to improve it?

4 responses to “Shunt or no shunt”

  1. Regarding hepatic

    Regarding hepatic echogenicity I use the falciform fat as a point of reference and the liver should be iso to slightly hypoechoic to the fal fat. Fal fat is more reliable as its always a consistent standoff pad in position and echotexture when imaging the liver as opposed to comparing spleen and kidney that get remodeled over time and are less consistent points of reference and are imagesd in a different plane. In fat cats the abundant falciform fat can enhance the liver and make it hyperechoic like a lipidotic liver. In those cases don’t call it lipidosis unless the sap +/- bilirubin are elevated as its likely just acoustic enhancement.

    As far as the abnormal vessel i agree it looks tortuous but sometimes the cvc just is tortuous without shunting especially if sedated with dex dom or similar. Ensure you line up the PV with the CVC in long axis  and measure at the PV right at its trifurcation as it enters the liver. From here you get your pv cvc ratio which is key. Add the ao in this view too to get pv ao ratio.

    If you havent downloaded my shunt hunt lectures these will spell it out more clearly.


    When in doubt the BA should be > 80 post prandial in shunts with rare exception and then CT with contrast for the rare ones that don’t follow the rules

    • I have attached some more

      I have attached some more videos of the portal hilus, which do prove that the extrahepatic shunt doesn’t exist. Please inform if these videos help to prove that the intrahepatic shunt exists or not or I will scan the cat again tomorrow to get better videos



  2. Thanks Erric for the reply.

    Thanks Erric for the reply. The cat was not sedated and the vessel seems to be intrahepatoc and not extrahepatic – thinking of extrahepatic shunts. I have another portal hilus view in which the PV is in 1:1 ratio with the CVC. I have watched your shunt lectures. I will upload the video of the portal hilus and the aorta shortly

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