Peripartum clinical manifestations of a mesentericorenocaval shunt in a Burmese cat

Case summary A 3-year-old entire female Burmese cat was presented for investigation of intermittent lethargy during gestation followed by persistent hypersalivation and ataxia postpartum. The cat had queened three litters in total, with clinical signs worsening during the most recent lactation period. Mild anaemia (26%), hypoglycaemia (2.4 mmol/l; reference interval [RI] 3.9–8.3 mmol/l) and increased postprandial serum bile acids (74 µmol/l; RI <25 µmol/l) were identified on initial bloodwork. Multiphase contrast-enhanced CT identified a mesentericorenocaval portosystemic shunt; this was attenuated surgically with an ameroid constrictor. Clinical signs resolved after surgery. Follow-up 3 months postoperatively revealed normal pre- and postprandial serum bile acids (2 µmol/l and 3 µmol/l, respectively) with repeat CT identifying evidence of shunt attenuation. The cat continued to be healthy and free of clinical signs 12 months postoperatively. Relevance and novel information Mesentericorenocaval portosystemic shunt morphology has not been previously reported in the cat and should be considered as a differential diagnosis for cats presenting with peripartum onset of malaise, ptyalism or ataxia.

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Recanalisation of a congenital extrahepatic portosystemic shunt previously attenuated with cellophane banding in a cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116918795717 ◽

2018 ◽

Vol 4 (2) ◽

pp. 205511691879571

Author(s):

James Crowley ◽

Timothy Foo ◽

Lara Boland ◽

Laurencie Brunel

Keyword(s):

Hepatic Encephalopathy ◽

Bile Acids ◽

Clinical Signs ◽

Reference Interval ◽

Portosystemic Shunt ◽

Liver Size ◽

Long Term Follow Up ◽

Stimulation Tests ◽

Congenital Extrahepatic Portosystemic Shunt ◽

Liver Changes

Case summary A congenital extrahepatic portosystemic shunt was attenuated with commercial roll cellophane banding in a cat and postoperative liver changes were monitored using CT angiography (CTA). The patient clinically improved after cellophane banding, characterised by resolution of hepatic encephalopathy, weight gain, reference interval (RI) bile acid stimulation tests, as well as CTA-documented increased liver size, increased hepatic vasculature and shunt attenuation. Six months later the cat re-presented with recurrence of clinical signs and increased bile acids. CTA confirmed recanalisation of the shunt. Shunt attenuation was repeated using pure cellophane banding and nearly complete closure of the shunt was later documented by CTA. Seven months later, recanalisation was again documented via CTA and associated with clinical signs and increased bile acids. Complete ligation of the shunt was achieved using a polypropylene ligature and a titanium ligating clip. At long-term follow-up, the cat was clinically well, and bile acids and biochemistry were within the RIs. Relevance and novel information This is the first report of CTA-documented recanalisation of an extrahepatic portosystemic shunt previously attenuated with cellophane banding. Recanalisation should be considered as a differential for recurrence of hepatic encephalopathy following cellophane banding.

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Suspected haemorrhagic cystitis in a dog as delayed complication after contrast-enhanced computed tomography

Veterinary Record Case Reports ◽

10.1136/vetreccr-2019-001011 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001011

Author(s):

Nausikaa Devriendt ◽

Norbert van de Velde ◽

Emmelie Stock ◽

Evelien de Bakker ◽

Hilde de Rooster

Keyword(s):

Ct Scan ◽

Clinical Signs ◽

Lumbar Vertebra ◽

Multimodal Analgesia ◽

Haemorrhagic Cystitis ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Delayed Complication ◽

Enhanced Computed Tomography

A 10-month-old female intact Australian shepherd dog was diagnosed with an intrapelvic mass. Blood and urinanalyses were unremarkable. A contrast-enhanced CT scan was performed to define the extent of the mass. A large, expansile, heterogeneous mass, extending from the ventral aspect of the last lumbar vertebra until the second caudate vertebra and invading the vertebral canal at the lumbosacral junction with displacement of all organs in the caudal abdomen, was diagnosed. Two days after the CT scan, the dog was euthanased because of deterioration of clinical signs despite the start of multimodal analgesia. Necropsy and subsequent histology and immunohistochemistry revealed the presence of a plasmacytoma and haemorrhagic cystitis. The haemorrhagic cystitis was most likely caused by the contrast agent used for the CT scan that remained in the bladder for a prolonged time, secondary to subobstruction of the urethra.

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Inaccuracy of serum bile acids to predict closure after surgical attenuation of a portosystemic shunt

Veterinary Record Case Reports ◽

10.1136/vetreccr-2017-000510 ◽

2018 ◽

Vol 6 (2) ◽

Cited By ~ 2

Author(s):

Nausikaa Devriendt ◽

Eva Vandermeulen ◽

Matan Or ◽

Dominique Paepe ◽

Hilde Rooster

Keyword(s):

Bile Acids ◽

Portosystemic Shunt ◽

Serum Bile Acids

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Surgical correction of a splenophrenic shunt in a dog: a case report

Veterinární Medicína ◽

10.17221/7660-vetmed ◽

2014 ◽

Vol 59 (No. 8) ◽

pp. 396-402

Author(s):

H. Yoon ◽

M. Roh ◽

S. Jeong

Keyword(s):

Bile Acids ◽

Clinical Presentation ◽

Clinical Signs ◽

Portosystemic Shunt ◽

Postoperative Results ◽

Lack Of Information ◽

Normal Ranges ◽

Portosystemic Shunts ◽

Different Types ◽

History Of

A 4.3 kg, nine-year-old, spayed female Shih Tzu was presented for a two-month history of seizures, ataxia, and hyper-salivation. A diagnosis of a splenophrenic shunt was made by use of computed tomography angiography with volume-rendered imaging. A cellophane band was placed around the shunt after its isolation from the central tendon of the diaphragm. Clinical signs continued to wax and wane. Preprandial and postprandial bile acids levels were still elevated 10 months after surgery. An ameroid ring constrictor was placed around the shunt vessel before the vessel entered the diaphragm from its caudal aspect. At three months after the second surgery, the dog was near the normal ranges of preprandial and postprandial bile acids. Although a study of the anatomy of different types of extrahepatic portosystemic shunts has been reported in dogs, to the authors’ knowledge, there is a lack of information on clinical presentation, treatment, and postoperative results in a specific type of extrahepatic portosystemic shunt, such as a splenophrenic shunt. Cellophane banding should be avoided for occlusion of a splenophrenic shunt passing along the central tendon of the diaphragm.  

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Cerebral Sinovenous Thrombosis

Interventional Neuroradiology ◽

10.1177/15910199080140s208 ◽

2008 ◽

Vol 14 (2_suppl) ◽

pp. 35-40 ◽

Cited By ~ 5

Author(s):

Hsian-Min Chen ◽

Clayton Chi-Chang Chen ◽

Fong Y Tsai ◽

Cherng-Gueih Shy ◽

Chen-Hoa Wu ◽

...

Keyword(s):

Anticoagulant Therapy ◽

Clinical Manifestations ◽

Dural Sinus ◽

Cerebral Vein ◽

Thrombolytic Treatment ◽

Post Contrast ◽

Cerebral Sinovenous Thrombosis ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Sinovenous Thrombosis

Cerebral sinovenous thrombosis (CSVT) is an uncommon disorder that affects the dural venous sinus and cerebral vein. In our study, thirty-four patients were examined. Pre and/or post contrast-enhanced CT was done in 28 patients. MRI studies were done in 24 patients. 2-D TOF MR venography (MRV) and contrast-enhanced MRV (CEMRV) were done in 19 cases. Digital subtraction angiography (DSA) was done in 18 patients. Sixteen patients received systemic intravenous heparinization, and 12 received endovascular thrombolytic treatment with urokinase combined with anticoagulant therapy. Neuroimages of CSVT can be acquired by direct visualization of the thrombus within the dural sinus or by parenchymal changes secondary to venous occlusion. As there are some pitfalls to MRI in the diagnosis of CSVT, the combination of MRI and MRV is now the gold standard in the diagnosis of CSVT. Usually, accuracy can be improved by applying 2-D TOF MRV and CE MRV. Furthermore, the source image of MRV is critical in differentiating between normal sinus variations and diseased ones. DSA is the best tool for demonstrating dynamic intracranial circulation in CSVT and mostly is used for endovascular treatment. Systemic intravenous anticoagulant therapy with heparin is accepted as a first line treatment. Except for clinical manifestations after systemic heparinization, abnormal MR findings of parenchymal change can be used to determine when to initiate thrombolytic treatment. Endovascular therapy can be finished at the ante-grade flow within the dural sinus and continuous anticoagulation is sufficient to facilitate clinical improvement. Clinical suspicion and excellent neuroimaging are crucial in making the diagnosis of CSVT. Proper management with anticoagulants and/or endovascular thrombolytic therapy is mandatory in preventing propagation of the thrombosis and improving the clinical outcome.

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Splenorenal Manifestations ofBartonella henselaeInfection in a Pediatric Patient

Case Reports in Radiology ◽

10.1155/2016/7803832 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Taylor Rising ◽

Nicholas Fulton ◽

Pauravi Vasavada

Keyword(s):

Fever Of Unknown Origin ◽

Bartonella Henselae ◽

Clinical Manifestations ◽

Unknown Origin ◽

Night Sweat ◽

Aged Patient ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Wide Range

Bartonella henselaeis a bacterium which can cause a wide range of clinical manifestations, ranging from fever of unknown origin to a potentially fatal endocarditis. We report a case ofBartonella henselaeinfection in a pediatric-aged patient following a scratch from a kitten. The patient initially presented with a prolonged fever of unknown origin which was unresponsive to antibiotic treatment. The patient was hospitalized with worsening fevers and night sweat. Subsequent ultrasound imaging demonstrated multiple hypoechoic foci within the spleen. A contrast-enhanced CT of the abdomen and pelvis was also obtained which showed hypoattenuating lesions in the spleen and bilateral kidneys.Bartonella henselaeIgG and IgM titers were positive, consistent with an acuteBartonella henselaeinfection. The patient was discharged with a course of oral rifampin and trimethoprim-sulfamethoxazole, and all symptoms had resolved following two weeks of therapy.

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