Diagnostic utility of computed tomographic angiography in dogs with portal vein thrombosis

Ultrasonographic characteristics of the portal venous system of 37 healthy, unsedated, student-owned cats: A prospective study

OBJECTIVE

The aim of this study was to determine portal vein and divisional branch diameters and portal vein velocities in healthy, unsedated cats, using B-mode and Doppler ultrasound.

ANIMAL

Thirty-seven healthy, adult cats, all owned by students.

PROCEDURE

Enrollment of cats in the study was done prospectively. Ultrasonographic imaging in both the longitudinal and transverse planes was assessed, with all examinations and measurements done by the same person. The assessment included the following 3 sites: extra-hepatic portion of the portal vein, intra-hepatic branches of the portal vein, and the aorta at the level of the porta hepatis. The Shapiro-Wilk test was used for normality and P < 0.05 was used to define statistical significance.

RESULTS

Both the extra-hepatic portion of the portal vein and the porta hepatis were identified in all 37 cats (100%), whereas the aorta was recorded in 31 (84%), and the left and right intra-hepatic branches of the portal vein were seen in 29 (78%). Pulsed-wave Doppler ultrasound of the portal vein was obtained in 32 cats (86%). In longitudinal view, average maximal diameter of the extra-hepatic portal vein was 3.6 mm (± 0.7 mm), and the mean portal flow velocity was 14.6 cm · s (± 4.3 cm · s). In transverse view, average maximal diameter was 4.8 mm (± 0.8 mm) for the extra-hepatic portal vein, and 3.1 mm (± 0.8 mm) and 2.6 mm (± 0.7 mm) for the left and right intra-hepatic branches, respectively. The portal-vein-to-aorta ratio averaged 1.2 (± 0.2).

CONCLUSION

This study produced sonographic data of the portal venous system in healthy, conscious adult cats, which may be useful during investigation of liver diseases, including congenital and acquired liver diseases.

Computed tomographic features of portal vein thrombosis in two cats with splenosystemic shunts

Two spayed female cats presented with hepatic encephalopathy due to hyperammonaemia. On abdominal ultrasound, concurrent portal vein thrombosis and splenosystemic shunts were suspected in both cats. Computed tomographic angiography clearly detected thrombi as non-contrast enhancing intraluminal structures in the main portal vein of both cats. Additionally, splenorenal shunts were revealed in both cats. Follow-up computed tomographic angiography for portal vein thrombosis was performed in both cats, only one of whom received anticoagulant therapy. In the untreated cat, portal vein thrombosis had progressed with the development of an aberrant tortuous vessel. In the cat treated with low-molecular-weight heparin, the thrombus progressively decreased in size and disappeared on follow-up diagnostic imaging. Computed tomographic angiography might be useful for the diagnosis and follow-up of portal vein thrombosis in cats.

Intrahepatic venous collaterals in dogs with congenital intrahepatic portosystemic shunts are associated with focal shunt or hepatic vein narrowing

Dogs with congenital intrahepatic portosystemic shunts (IHPSS) occasionally have multiple smaller intrahepatic, tortuous blood vessels surrounding the primary shunt. This study was a retrospective, observational design that was also descriptive and anatomic in nature. Objectives were to characterize vascular morphology in IHPSS dogs presenting with intrahepatic venous collaterals (IVCs) relative to IHPSS dogs without IVCs, and to propose reasons for IVC development. The authors hypothesized that (a) IVCs develop secondary to flow resistance around a focal area of a shunt or draining hepatic vein narrowing and (b) the presence of IVC is associated with portal vessel development before intervention. Anonymized CT angiograms (CTA) and fluoroscopic portovenograms (FPV) of dogs with IHPSS were evaluated for the presence of IVCs, focal narrowing within the IHPSS, and intrahepatic portal vessels >5 mm long. Eleven of 47 (23%) dogs had IVCs identified. IVCs were significantly associated with focal narrowing in the shunt or draining hepatic vein on CTA (P = 0.039) and FPV (P = 0.021). IVCs were not associated with the presence of intrahepatic portal branches >5 mm long on portovenography (P = 0.42) or CTA (P = 0.49). Focal narrowing in the shunt (circumferential soft tissue narrowing >20% of the shunt diameter) was significantly associated with intrahepatic portal branches >5 mm long on both modalities (P < 0.001). IVCs are associated with focal narrowing of the shunt or draining hepatic vein in dogs with IHPSS. IVC should be distinguished from other conditions when evaluating a CTA for canine IHPSS.

Long-term follow-up of portal vein thrombosis in an American Cocker Spaniel with lobular dissecting hepatitis: a case report

BACKGROUND

Lobular dissecting hepatitis (LDH) is a rare form of canine liver cirrhosis that may be accompanied by portal hypertension in American Cocker Spaniels. In human patients with liver cirrhosis, portal vein thrombosis (PVT) is a common complication. However, PVT has not been reported in dogs with LDH. Herein, we describe the long-term follow-up of PVT in an American Cocker Spaniel with LDH.

CASE PRESENTATION

An 8-year-old neutered male American Cocker Spaniel presented with a 1-month history of severe abdominal effusion. The dog was histopathologically diagnosed with LDH and treated with low-dose prednisolone on day 14. On day 115, computed tomography angiography (CTA) confirmed the presence of a thrombus in the portal vein. Therefore, the dog was subcutaneously administered with the anticoagulant dalteparin, and low-dose prednisolone was continued. As a follow-up for PVT, CTA examinations were performed on days 207, 515, 886, and 1168, and the dog's antithrombin and D-dimer levels were measured. Following anticoagulant therapy, the dog was confirmed to have gradually increased antithrombin activity and decreased D-dimer concentrations. In addition, although the thrombus was confirmed to be in the same area of the portal vein system by CTA, atrophy and increased CT values due to organization were observed during the follow-up period. The dog's condition remained stable without clinical signs until day 1112 when it developed hepatic encephalopathy. The dog died on day 1208. On postmortem examination, histopathologically, the liver showed marked bile duct hyperplasia and fibrosis with chronic thrombus in the portal vein.

CONCLUSIONS

This case demonstrated that low-dose glucocorticoid combined with dalteparin allowed long-term follow-up of PVT in an American Cocker Spaniel with LDH.