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Radiologic Evaluation of Portosystemic Shunts in Humans and Small Animals: Review of the Literature with Clinical Case Reports. Diagnostics (Basel) 2023; 13:diagnostics13030482. [PMID: 36766586 PMCID: PMC9914644 DOI: 10.3390/diagnostics13030482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The portal venous system is a network of vessels that carry blood from the capillary beds of the major abdominal organs to the liver. During embryology, the portal venous system can develop aberrantly, leading to vascular connections between the portal and systemic venous circulation known as portosystemic shunts. The purpose of this comparative review with a few short representative case reports was to present the similarities and differences in portosystemic shunts in humans and small animals and their radiologic evaluation. Aberrant vascular connections between the portal and systemic venous circulation enable portal blood to bypass metabolism and detoxification in the liver, leading to significant clinical implications. Portosystemic shunts are very rare in humans, but these connections are much more common in small animals, affecting up to 0.6% of small animals. Portosystemic shunts can be congenital or acquired and are divided into intrahepatic and extrahepatic types. Because of its ability to accurately assess abdominal structures, large vessels, and their flow dynamics without anesthesia, ultrasonography has become the first imaging modality employed for the diagnostic evaluation of portosystemic shunts in both humans and small animals. This is usually followed by contrast-enhanced computed tomographic angiography in order to better define the exact shunt anatomy and to plan treatment. It is important to understand the embryology, anatomy, pathology, and pathophysiology of portosystemic shunts in order to understand the findings of radiologic imaging and to initiate appropriate treatment.
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Plested MJ, Zwingenberger AL, Brockman DJ, Hecht S, Secrest S, Culp WTN, Drees R. Canine intrahepatic portosystemic shunt insertion into the systemic circulation is commonly through primary hepatic veins as assessed with CT angiography. Vet Radiol Ultrasound 2020; 61:519-530. [PMID: 32663370 DOI: 10.1111/vru.12892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/15/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023] Open
Abstract
Congenital intrahepatic portosystemic shunts (IHPSS) in dogs are traditionally classified as right, left, or central divisional. There are few descriptive studies regarding the variation of IHPSS within these categories. This multicenter, analytical, cross-sectional study aimed to describe a large series of dogs with CT angiography (CTA) of IHPSS, hypothesizing that there would be variation to the existing classification. Ninety CTA studies were assessed for IHPSS type, insertion, and the relationship of the insertion to the primary hepatic veins. Ninety-two percent of IHPSS inserted into a primary hepatic vein (HV) or phrenic vein, 8% inserted directly into the ventral aspect of the intrahepatic caudal vena cava. The most common IHPSS type was a single right divisional (44%), including those inserting via the right lateral HV or the caudate HV. Left divisional IHPSS (33%) inserted into the left HV or left phrenic vein. Central divisional IHPSS (13%) inserted into the quadrate HV, central HV, dorsal right medial HV, or directly into the ventral aspect of the intrahepatic caudal vena cava. Multiple sites of insertion were seen in 9% of dogs. Within left, central, and right divisional types, further subclassifications can therefore commonly be defined based on the hepatic veins with which the shunting vessel communicates. Relating IHPSS morphology to the receiving primary HV could make IHPSS categorization more consistent and may influence the type and method of IHPSS attenuation recommended.
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Affiliation(s)
- Mark J Plested
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, Davis, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Daniel J Brockman
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | - Scott Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - William T N Culp
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | - Randi Drees
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
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Specchi S, d'Anjou MA. Diagnostic imaging for the assessment of acquired abdominal vascular diseases in small animals: A pictorial review. Vet Radiol Ultrasound 2019; 60:613-632. [PMID: 31243852 DOI: 10.1111/vru.12780] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/26/2022] Open
Abstract
Advances in interventional radiology and surgical techniques now allow complex abdominal diseases to be more successfully treated in small animals. Abdominal vascular alterations, acquired as individual process or as complication of other lesions such as neoplasia, can be life-threatening or at least greatly limit curative interventions of underlying diseases. Computed tomography (CT) and high-definition ultrasonography are now readily available in veterinary referral centers. Yet, there is little information currently available on the use of these modalities for the diagnosis and characterization of these vascular alterations. The purpose of this article is to review the CT and ultrasonographic findings of acquired vascular diseases in the abdomen of dogs and cats, using both the veterinary and human medicine literature as references, and highlighting essential concepts through figures.
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Affiliation(s)
- Swan Specchi
- Ospedale Veterinario i Portoni Rossi, Bologna, 40069, Italy.,Animages, Longueuil, Quebec, J4G 2L2, Canada
| | - Marc-André d'Anjou
- Ospedale Veterinario i Portoni Rossi, Bologna, 40069, Italy.,Animages, Longueuil, Quebec, J4G 2L2, Canada
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Bertolini G. Anomalies of the Portal Venous System in Dogs and Cats as Seen on Multidetector-Row Computed Tomography: An Overview and Systematization Proposal. Vet Sci 2019; 6:vetsci6010010. [PMID: 30678218 PMCID: PMC6466037 DOI: 10.3390/vetsci6010010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 01/01/2023] Open
Abstract
This article offers an overview of congenital and acquired vascular anomalies involving the portal venous system in dogs and cats, as determined by multidetector-row computed tomography angiography. Congenital absence of the portal vein, portal vein hypoplasia, portal vein thrombosis and portal collaterals are described. Portal collaterals are further discussed as high- and low-flow connections and categorized in hepatic arterioportal malformation, arteriovenous fistula, end-to-side and side-to-side congenital portosystemic shunts, acquired portosystemic shunts, cavoportal and porto-portal collaterals. Knowledge of different portal system anomalies helps understand the underlying physiopathological mechanism and is essential for surgical and interventional approaches.
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Affiliation(s)
- Giovanna Bertolini
- San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, 35030 Veggiano, Padova, Italy.
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Specchi S, Rossi F, Weisse C, Morabito S, Petrovitch NP, Drees R, Thierry F, Ricciardi M, Penchome R, Armenise A, Pey P, Paek M, Panopoulos I, Nicoli S, Schwarz T. Canine and feline abdominal arterioportal communications can be classified based on branching patterns in computed tomographic angiography. Vet Radiol Ultrasound 2018; 59:687-696. [DOI: 10.1111/vru.12685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/04/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Swan Specchi
- Diagnostic Imaging; Istituto Veterinario di Novara; Granozzo con Monticello Novara 28060 Italy
| | | | - Chick Weisse
- Animal Medical Center; New York New York 10065 USA
| | - Simona Morabito
- Diagnostic Imaging; Istituto Veterinario di Novara; Granozzo con Monticello Novara 28060 Italy
| | | | - Randi Drees
- The Royal Veterinary College; Hatfield AL97TA UK
| | - Florence Thierry
- Royal (Dick) School of Veterinary Studies & Roslin Institute; University of Edinburgh; Roslin EH25 9RG UK
| | - Mario Ricciardi
- Ospedale Veterinario; Pingry via delle Medaglie d'Oro 5; Bari 70126 Italy
| | - Rampaipat Penchome
- Diagnostic Imaging Unit; Faculty of Veterinary Science; Small Animal Teaching Hospital; Chulalongkorn University; Bangkok Thailand
| | | | - Pascaline Pey
- École Nationale Vétérinaire d'Alfort; Maisons-Alfort 94799 France
| | - Matthew Paek
- Synergy Veterinary Imaging Partners, Radiology; Maryland 21029 USA
| | - Ioannis Panopoulos
- Diagnostic Imaging; Istituto Veterinario di Novara; Granozzo con Monticello Novara 28060 Italy
- Alphavet Veterinary Clinic; Athens 14564 Greece
| | - Stefano Nicoli
- Diagnostic Imaging; Istituto Veterinario di Novara; Granozzo con Monticello Novara 28060 Italy
- Clinica Veterinaria Roma Sud; Roma 00173 Italy
| | - Tobias Schwarz
- Royal (Dick) School of Veterinary Studies & Roslin Institute; University of Edinburgh; Roslin EH25 9RG UK
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Specchi S, d’Anjou MA, Carmel EN, Bertolini G. COMPUTED TOMOGRAPHIC CHARACTERISTICS OF COLLATERAL VENOUS PATHWAYS IN DOGS WITH CAUDAL VENA CAVA OBSTRUCTION. Vet Radiol Ultrasound 2014; 55:531-8. [DOI: 10.1111/vru.12167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 01/17/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Swan Specchi
- Department of Clinical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; 3200 Rue Sicotte, J2S7C6 Sainte Hyacinthe Québec Canada
| | - Marc-André d’Anjou
- Department of Clinical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; 3200 Rue Sicotte, J2S7C6 Sainte Hyacinthe Québec Canada
| | - Eric Norman Carmel
- Department of Clinical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; 3200 Rue Sicotte, J2S7C6 Sainte Hyacinthe Québec Canada
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Miyawaki S, Washizu M, Maeda S, Shibata S, Watanabe K, Yamazoe K. Portal vein aneurysm in a dog. J Vet Med Sci 2012; 74:1191-3. [PMID: 22571895 DOI: 10.1292/jvms.11-0575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Portal vein aneurysm (PVA) is a rare abnormal dilatation of the portal vein, which has not been reported in dogs. We describe the findings of ultrasound and computed tomography in a case of PVA in a young male toy poodle, with the final diagnosis established by explorative surgical observation. The dog had an aneurysmal fusiform dilatation in the extrahepatic portal vein with portal hypertension and multiple portsystemic shunts. This is the first report of canine PVA.
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Affiliation(s)
- Shingo Miyawaki
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1193, Japan
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Bertolini G, Caldin M. Computed tomography findings in portal vein aneurysm of dogs. Vet J 2012; 193:475-80. [PMID: 22269874 DOI: 10.1016/j.tvjl.2011.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 12/09/2011] [Accepted: 12/14/2011] [Indexed: 01/16/2023]
Abstract
In this retrospective study, the appearances of extrahepatic and intrahepatic portal vein aneurysms (PVAs) in dogs were evaluated using multidetector computed tomography (CT). Data from 3060 dogs that underwent abdominal CT were reviewed for focal portal vein dilatation. PVAs were detected in 15/3060 (0.49%) dogs. The bodyweights of dogs with PVAs were significantly higher than the bodyweights of dogs without aneurysms (P=0.0001). Male sex was also significantly associated with PVAs (OR=6.23). Boxers were predisposed to the development of PVA (OR=11.88). Extrahepatic PVAs were always located in the portal vein at the level of the gastroduodenal vein insertion and were saccular in 10/15 dogs and fusiform in 5/15 dogs. One dog had an additional intrahepatic aneurysm of the umbilical part of the left intrahepatic portal branch. No dogs had clinical signs related to the PVA(s), although one dog developed a portal vein thrombosis in the site of the aneurysm.
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Affiliation(s)
- G Bertolini
- San Marco Veterinary Clinic, Via Sorio 114/c, 35141 Padua, Italy.
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Nelson NC, Nelson LL. Anatomy of extrahepatic portosystemic shunts in dogs as determined by computed tomography angiography. Vet Radiol Ultrasound 2011; 52:498-506. [PMID: 21599793 DOI: 10.1111/j.1740-8261.2011.01827.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Congenital extrahepatic portosystemic shunts are anomalous vessels joining portal and systemic venous circulation. These shunts are often diagnosed sonographically, but computed tomography (CT) angiography produces high-resolution images that give a more comprehensive overview of the abnormal portal anatomy. CT angiography was performed on 25 dogs subsequently proven to have an extrahepatic portosystemic shunt. The anatomy of each shunt and portal tributary vessels was assessed. Three-dimensional images of each shunt type were created to aid understanding of shunt morphology. Maximal diameter of the extrahepatic portosystemic shunt and portal vein cranial and caudal to shunt origin was measured. Six general shunt types were identified: splenocaval, splenoazygos, splenophrenic, right gastric-caval, right gastric-caval with a caudal shunt loop, and right gastric-azygos with a caudal shunt loop. Slight variations of tributary vessels were seen within some shunt classes, but were likely clinically insignificant. Two shunt types had large anastomosing loops whose identification would be important if surgical correction were attempted. A portal vein could not be identified cranial to the shunt origin in two dogs. In conclusion, CT angiography provides an excellent overview of extrahepatic portosystemic shunt anatomy, including small tributary vessels and loops. With minor variations, most canine extrahepatic portosystemic shunts will likely be one of six general morphologies.
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Affiliation(s)
- Nathan C Nelson
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48864, USA.
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MAI WILFRIED, WEISSE CHICK. CONTRAST-ENHANCED PORTAL MAGNETIC RESONANCE ANGIOGRAPHY IN DOGS WITH SUSPECTED CONGENITAL PORTAL VASCULAR ANOMALIES. Vet Radiol Ultrasound 2010; 52:284-8. [DOI: 10.1111/j.1740-8261.2010.01771.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Brinkman-Ferguson EL, Biller DS. Ultrasound of the Right Lateral Intercostal Space. Vet Clin North Am Small Anim Pract 2009; 39:761-81. [DOI: 10.1016/j.cvsm.2009.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schwarz T, Rossi F, Wray JD, Åblad B, Beal MW, Kinns J, Seiler GS, Dennis R, McConnell JF, Costello M. Computed tomographic and magnetic resonance imaging features of canine segmental caudal vena cava aplasia. J Small Anim Pract 2009; 50:341-9. [DOI: 10.1111/j.1748-5827.2009.00748.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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