A small breed puppy with a heart murmur, elevated pre & post bile acids, bladder calculi, and small liver. Shunt-hunt mode: ENGAGED. When evaluating the portal hilus what should the ratio of the 3 main vessels be to each other? The portal vein, caudal vena cava, and aorta in the portal hilus should be at a 1:1 ratio in a normal patient. SonoPath Mobile’s Diane Mcfadden, BS, RVT, SDEP® certified clinical sonographer captured the high-end views needed to properly diagnose this little one’s liver shunt. Detailed interpretation by Eric Lindquist, DMV, DABVP, Cert. IVUSS.
A 10 lb, 9-month-old intact male Shih Tzu puppy with a heart murmur presented for vomiting and lethargy following dietary indiscretion.
A 10 lb, 9-month-old intact male Shih Tzu puppy with a heart murmur presented for vomiting and lethargy following dietary indiscretion.
The urinary bladder revealed small calculi, the largest grouping of which measured 5.0 mm, nonobstructive at the time of the sonogram. The kidneys were swollen and hypervascular. The liver was subnormal in size with moderate to severe microhepatica. The gallbladder and common bile duct were unremarkable. The portal vein was subnormal in size. Extrahepatic portosystemic shunt present, width of approximately 8.0 mm, appeared to be deriving from the splenic vein juncture with the portal vein, decoursing dorsally and entering into the vena cava. The residual portal vein measured 4.0 mm. The shunt measured maximum 8.0 mm. The vena cava measured 7.0 mm. The aorta measured 5.0 mm at the portal hilus.
Clinical management with hepatic bile acid elevation support protocol was recommended until surgical intervention can occur for correction of splenocaval shunting. At last communication, the patient was having serial ultrasound rechecks to track the progression of the shunt.
