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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.

Keywords

TSSOBU_2018_v58n4_227_f0001.png 이미지

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.

TSSOBU_2018_v58n4_227_f0003.png 이미지

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.

References

  1. Bertolini G. Acquired portal collateral circulation in the dog and cat. Vet Radiol Ultrasound 2010, 51, 25-33. https://doi.org/10.1111/j.1740-8261.2009.01616.x
  2. Buob S, Johnston AN, Webster CRL. Portal hypertension: pathophysiology, diagnosis, and treatment. J Vet Intern Med 2011, 25, 169-186. https://doi.org/10.1111/j.1939-1676.2011.00691.x
  3. Buote NJ, Mitchell SL, Penninck D, Freeman LM, Webster CRL. Cholecystoenterostomy for treatment of extrahepatic biliary tract obstruction in cats: 22 cases (1994-2003). J Am Vet Med Assoc 2006, 228, 1376-1382. https://doi.org/10.2460/javma.228.9.1376
  4. Center SA. Diseases of the gallbladder and biliary tree. Vet Clin North Am Small Anim Pract 2009, 39, 543-598. https://doi.org/10.1016/j.cvsm.2009.01.004
  5. Choi SH, Han JK, Lee JM, Lee KH, Kim SH, Lee JY, Choi BI. Differentiating malignant from benign common bile duct stricture with multiphasic helical CT. Radiology 2005, 236, 178-183. https://doi.org/10.1148/radiol.2361040792
  6. Cornell KK, Jakovljevic S, Waters DJ, Prostredny J, Salisbury SK, DeNicola DB. Extrahepatic biliary obstruction secondary to diaphragmatic hernia in two cats. J Am Anim Hosp Assoc 1993, 29, 502-507.
  7. Gaillot HA, Penninck DG, Webster CRL, Crawford S. Ultrasonographic features of extrahepatic biliary obstruction in 30 cats. Vet Radiol Ultrasound 2007, 48, 439-437. https://doi.org/10.1111/j.1740-8261.2007.00275.x
  8. Johnson SE. Portal hypertension. Part I. Pathophysiology and clinical consequences. Compend Contin Educ Pract Vet 1987, 9, 741-748
  9. Laing FC, Jeffrey RB Jr, Wing VW, Nyberg DA. Biliary dilatation: defining the level and cause by real-time US. Radiology 1986, 160, 39-42. https://doi.org/10.1148/radiology.160.1.3012631
  10. Langdon P, Cohn LA, Kreeger JM, Priddy NH. Acquired portosystemic shunting in two cats. J Am Anim Hosp Assoc 2002, 38, 21-27 https://doi.org/10.5326/0380021
  11. Leveille R, Biller DS, Shiroma JT. Sonographic evaluation of the common bile duct in cats. J Vet Intern Med 1996, 10, 296-299. https://doi.org/10.1111/j.1939-1676.1996.tb02065.x
  12. Mayhew PD, Holt DE, McLear RC, Washabau RJ. Pathogenesis and outcome of extrahepatic biliary obstruction in cats. J Small Anim Pract 2002, 43, 247-253. https://doi.org/10.1111/j.1748-5827.2002.tb00067.x
  13. Williams EJ, Iredale JP. Liver cirrhosis. Postgrad Med J 1998, 74, 193-202. https://doi.org/10.1136/pgmj.74.870.193
  14. Wisner ER, Zwingenberger AL. Atlas of Small Animal CT and MRI. pp. 522-536, Wiley Blackwell, Ames, 2015.
  15. Zawie DA, Shaker E. Diseases of the liver. In: Sherding RG (ed.). The Cat. Diseases and Clinical Management. pp. 1015-1036, Churchill Livingstone, New York, 1989.