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Imaging diagnosis of extrahepatic biliary tract obstruction with acquired portosystemic shunt in a cat

  • Hwang, Tae-Sung (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Jang, Won-Seok (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Yoon, Young-Min (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Jung, Dong-In (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Lee, Hee Chun (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University)
  • Received : 2018.11.14
  • Accepted : 2018.12.18
  • Published : 2018.12.31

Abstract

A 2-year-old, spayed female, Korean domestic short-hair cat was presented with depression and vomiting. The patient had history of weight loss lasting seven months. Physical examination revealed icterus in the pinna, oral mucosa, and sclera. Based on ultrasonography and computed tomography, tentative diagnosis was extrahepatic biliary tract obstruction with acquired portosystemic shunt (PSS). Tumor or inflammation of hepatobiliary system was suspected as the cause of obstruction of the common bile duct. But it could not be determined without biopsy. The severely dilated cystic duct was considered to cause portal hypertension and secondary multiple PSS. The patient expired without histopathologic examination.

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Fig. 1. Abdominal ultrasonographic images of the cat. (A) Gallbladder with irregularly thickened wall (arrow) is found. Gravity-dependent echogenic sludge (arrowhead) is also identified. (B) Severely dilated cystic duct is observed. (C) Severely and tortuously dilated intrahepatic duct (arrow) and anechoic free fluid (arrowhead) are identified. (D) Tortuous vessels (arrow head) around urinary bladder were found. They were thought to be originated from the spleen. G, gallbladder; CD, cystic duct; U, urinary bladder.

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Fig. 3. Transverse view of contrast enhanced computed tomography images of the cat. (A and B) Portal vein (arrowheads) compressed by dilated cystic duct is observed. (C) At the level of right kidney, peritoneal effusion is detected in the right ventral abdominal cavity. (D−F) Varicose veins (arrows) are identified between spleen and descending colon. The vessels were originated from the spleen. It is also found that the vessels are entering caudal vena cava (asterisk) at the level of descending colon. RK, right kidney.

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Fig. 2. Transverse view of precontrast (A) and contrastenhanced (B−D) computed tomography images of the cat. (A)Severely dilated cystic duct (CD) is present. Mildly irregularcontour of the liver (L) is also identified. (B) Dilated intrahe-patic ducts (arrows) are observed. (C) Focal thickening and con-trast enhancement of distal common bile duct wall (arrow) areidentified. (D) During the portal phase, mildly heterogeneousenhanced hepatic parenchyma with irregular contour is found.Severely dilated CD is also identified. GB, gallbladder.

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