global sonographic parameters in portosystemic shunts in 38 dogs & cats e lindquist, d casey, j...
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Global Sonographic Parameters
In Portosystemic Shunts In 38 Dogs & Cats
E Lindquist, D Casey, J Frank
Eric Lindquist DMV , DABVP (Canine & Feline Practice)
Director: Sound-Eklin New Jersey Mobile Associates
Founder: SonoPath.com
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To Shunt Or Not To Shunt?
That Is The Question.
To ShuntNot To Shunt
PV/CVC ≥0.75 and PV/AO ≥ 0.8. D‘Anjou et. al. Vet rad and US Vol 45, No
5 2004 102 pqtients
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Study Premise:
Attempt to stabilize a reliable global and precise sonographic criteria to diagnose or rule out the presence of portosystemic shunting
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Study Design: Retrospective 5 Sonographers, Trained By 1 Single Evaluator Experienced in Dx Of PSS 33 Dogs & Cats with EHPSS
5 Dogs With Intrahepatic Shunts
Age Range: 2 mo- 12 yr 19/38 Sx Confirmed Bile Acids: 93-473
umol/L US Evaluation of
Bladder, Kidneys, Liver Size, PV:CVC and PV:AO Ratios
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Parameter 1: The BladderNormal:
No Calculi Or Sediment
Calculi Or Sediment 24/33 (73%) EHPSS Cases. 2/5
IHPSS(40%). 68% overall.
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Parameter 2: The KidneysNormal:
No Renal Calculi
Renal Calculi 32/33 (97%) Of EHPSS Cases. 3/5 for
IHPSS(60%). 92% overall
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Parameter 3: Renomegaly
EHPSS 29/33. 88%IHPSS 2/5. 40%
82 % Overall
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Parameter 3: Liver SizeNormal:
Subjectively Normal Liver Size
Microhepatica 33/33 EHPSS. 5/5 IHPSS.
100% Of Cases Overall
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Parameters 4 & 5: Normal Portal Hilus; PV:CVC, PV:AO
RatiosNormals: PV/CVC ≥0.75 and PV/AO ≥ 0.8.
D‘Anjou et. al. Vet Rad US Vol. 45, No 5, 2004. 102 Patients
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Intrahepatic Shunt Parameters
Bladder Sand/Stones: 2/5
Renal Calculi: 3/5 Renomegaly: 2/5 Microhepatica: 5/5 PV:CVC Ratio: 1:1 PV:AO Ratio: 1:1 CVC:AO Ratio: 1:1
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Types Of Extrahepatic Shunts: 9 Gastrocaval (Looping), 18
Splenocaval (Short), 6 Splenoazygos (Long minimally curved)
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Caval Shunts:Increased Vena Cava Volume
Gastrocaval Splenocaval
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Scanning Target: Excessive Vena Caval Volume For Gastrocaval &
Splenocaval Shunts
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Caval EHPSS: 9 Gastrocaval & 18 Splenocaval Shunt Ratios
(Normals PV/CVC ≥0.75 and PV/AO ≥ 0.8.)
Gastrocaval: PV/CVC: 0.4-0.67
PV/AO: 0.4-0.71
Splenocaval: PV/CVC: 0.28-0.75
PV/AO: 0.4-0.78
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Azygos EHPSS Shunt Parameters
Azygos Shunt Bypasses The Cava Normal CVC:AO Ratio
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6 Azygos Shunts: Normal Vena Cava Volume:
Ratios: PV/CVC:0.4-0.63 PV/AO: 0.4-0.68
PV Pre/Post Shunt Differential Double Aorta
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PV/CVC Ratio 38 cases
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PV/AO Ratio 38 Cases
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Study Flaws
Published Controls Non blinded Urolithiasis is a non
specific finding Microhepatica &
renomegaly are subjective parameters
Caval probe pressure creates a variable
Small number of cases (38)
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ConclusionsIn this population of 38 dogs
and cats, the presence of : Urinary bladder
sand/calculi, Renal mineralization Renomegaly Microhepatica
were reliable, non exclusive, positive predictive factors for the presence of PSS , but do not distinguish IHPSS from EHPSS.
Subnormal PV/CVC and PV/AO ratios (0.7 8 or less) are highly reliable indicators of the presence of EHPSS.