CT: Extrahepatic Portosystemic Shunt in a 2-year-old FS Chihuahua :Our Case Of the Month August 2015

The shunt hunt and the Vimago CT examination. This month we cross the waters form ultrasound into computed tomography, particularly that of the coolest CT on earth that you may have heard about, the mobile high resolution Vimago CT. The Vimago plugs and plays into any room you could install an X-ray unit because it gives off 20% of the radiation of a standard CT with comparable or better contrast resolution. Dr. Nele Ondreka and Dr. Bob Obrien read the CT cases that come through sonopath teleradiology service. I personally have mixed feelings because I love the shunt hunt by the ultrasound probe. But all is fair in the art of veterinary medicine and CT with contrast is traditionally the most sensitive and specific modality for the shunt hunt. Here is one of those Vimago Shunt Hunts interpreted by Dr. Ondreka, Head of Clinical Radiology for the University of Giessen, Germany. Image sets obtained by Dr. Tina Neel and staff at Neel Veterinary Hospital, Oklahoma City, OK, USA.

History

Presented for Fanconi-like clinical signs. Ultrasound revealed possible liver shunt. Physical exam was unremarkable.

Presented for Fanconi-like clinical signs. Ultrasound revealed possible liver shunt. Physical exam was unremarkable.

DX

Large solitary extrahepatic portosystemic shunt.

Image Interpretation

CT, portal angiogram: A large tortuous vessel is seen connecting the portal vein to the caudal vena cava. This is an aberrant vessel which increases the diameter of the caudal vena cava more than two-fold. Shunt vessel measures approximately 6.3 mm at its widest point, approximately the same diameter as the caudal vena cava going through the diaphragm. There is no evidence of urolithiasis. There is no evidence of pleural free fluid. There is no evidence of intrathoracic abnormalities.

Outcome

Recommend surgical attenuation of the shunt vessel as clinically indicated.

Patient Information

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