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