Tuesday 22nd Jan, 2019
"Eddy" presented with a history of dullness, lethargy, occasional head pressing and a poorer appetite than normal.
We performed biochemistry, haematology and a bile acid stimulation test which was suggestive of a portosystemic shunt.
But what kind of shunt was it, and where was it, and was there only one?
To answer these questions CT angiography is the gold-standard test. We performed dual phase angiography using intravenous contrast and a multiphase scan, allowing us to identify the arterial and portal vasculature. A 3D reconstruction of these images was then performed, showing the origin and departure of the shunt, which was confirmed as being a single extrahepatic congenital portocaval shunt.
The next question was to how best to treat this shunt? After a couple of weeks of pre-op stabilisation and medical management, a 6mm ameroid was placed around the shunt vessel which will gradually occulde the blood flow through the shunt.
Eddy recovered well after his surgery: the biggest challenge during his recovery being looking after a livelier, more active and cheeky Eddy!
CT is a great resource and tool. If you have a case that you think this could help you with please do not hesitate to get in touch.