Contact Dr. Lindquist for consultation 1-800-838-4268 or info@sonopath.com
Skip to main content

Splenocaval Shunt with Minor Microhepatica in a 1-year-old MN DSH Cat: Our Case Of the Month November 2018

Patient Information

Age
1 Year
Gender
Male, Neutered
Species
Feline

Keywords

Images

Image 1: The portal vein continued deep into the cranial liver until its separation and measures 0.55 cm
Image 2: The portal vein continued deep into the cranial liver until its separation and measures 0.55 cm
Image 3: The portal vein revealed a 1:1 with the vena cava. This would be abnormal in dogs; however, cats can have a normal portal vein to vena cava ratio.
Image 4: The shunt discoursed dorsally and then entered the vena cava dorsally with an undulating contour. The length of the shunt was approximately 1.5 cm with a width of 0.5 cm.
Image 5: .The shunt discoursed dorsally and then entered the vena cava dorsally with an undulating contour. The length of the shunt was approximately 1.5 cm with a width of 0.5 cm.

A smaller than average cat or dog, failing to thrive, with high post-prandial bile acids all points to a likely liver shunt. It is critical to be able to obtain solid images of the liver and the portal hilus to acheive the diagnosis. Dr. Eric Lindquist imaged this smaller than average feline patient and identified a definitive splenocaval shunt utilizing SDEP™ positions 13 and 14 along with Doppler evaluation. Diagnosis, corrective surgery, and the cat is doing well post-op and thriving. Special thanks to Dr. Kristen Casulli, Dr. Chris Hallihan, and the attentive staff at Animal Care Centers of Flanders for the management of this case.

Every sonographer can easily develop the skills to rule-in or rule-out both intrahepatic and extrahepatic shunts. The technique is built into the SDEP™ 17-point protocol that SonoPath teaches at all of our 3 day SDEP™ abdominal lecture and wet labs. For more information or to register for one of our 2019 labs click here: 2019 SonoPath SDEP™ Veterinary Ultrasound Training

History

The patient has hepatic encephalopathy, which responds to Clindamycin and Lactulose. Bile acids pre: 127, post: 260.

Image Interpretation

The liver presented mild coarse architecture and increased portal markings. The portal vein revealed a 1:1 with the vena cava. This would be abnormal in dogs; however, cats can have a normal portal vein to vena cava ratio. The portal vein measured 0.55 cm, vena cava 0.47 cm. The portal vein continued deep into the cranial liver until its separation. However, a definitive splenocaval shunt was identified approximately 1.0 cm prior to the portal hilus and measured 0.5 cm in width. This decoursed dorsally and then entered the vena cava dorsally with an undulating contour. The length of the shunt was approximately 1.5 cm with a width of 0.5 cm.

DX

Splenocaval shunt with normal portal vein to vena cava ratio. Minor microhepatica.

Outcome

Recommend surgical intervention with ameroid constrictor therapy and concurrent liver biopsy +/- renal biopsy. The patient underwent shunt repair surgery with ameroid ring constrictor placement and did well post-operative. Follow up blood work found all values completely normalized. The patient continues to thrive at home and at his last wellness check up he weighed 11.6 pounds compared to his pre-shunt treatment weight of 6 pounds.

Videos

Video 1: The portal vein revealed a 1:1 with the vena cava.
Video 2: The arrow is pointing to the shunt. The portal vein revealed a 1:1 with the vena cava.