title: Use of transsplenic injection of agitated saline and heparinized blood for the ultrasonographic diagnosis of macroscopic portosystemic shunts in dogs.
abstract: We describe the use of ultrasonography-guided percutaneous splenic injection of agitated saline and heparinized blood for the diagnosis of portosystemic shunts (PSS) in 34 dogs. Agitated saline mixed with 1 ml of heparinized autologous blood was injected into the spleen of 34 sedated dogs under sonographic guidance. The transducer was then sequentially repositioned to visualize the portal vein, the caudal vena cava, and the right atrium through different acoustic windows. It was possible to differentiate between intrahepatic and extrahepatic shunts depending on the entry point of the microbubbles into the caudal vena cava. Portoazygos shunts and portocaval shunts could be differentiated based on the presence of microbubbles in the caudal vena cava and/or the right atrium. In one dog, collateral circulation due to portal hypertension was identified. In dogs with a single extrahepatic shunt, the microbubbles helped identify the shunting vessel. The technique was also used postoperatively to assess the efficacy of shunt closure. All abnormal vessels were confirmed by exploratory laparotomy or with ultrasonographic identification of the shunting vessel. Ultrasound-guided transsplenic injection of agitated saline with heparinized blood should be considered as a valuable technique for the diagnosis of PSS; it is easy to perform, safe, and the results are easily reproducible.
authors.affiliation: Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain. pablogomezochoa@gmail.com
authors.forename: Pablo
authors.initials: P
authors.lastname: Gómez-Ochoa
authors.forename: Francisco
authors.initials: F
authors.lastname: Llabrés-Díaz
authors.forename: Sergio
authors.initials: S
authors.lastname: Ruiz
authors.forename: Andrea
authors.initials: A
authors.lastname: Corda
authors.forename: Saul
authors.initials: S
authors.lastname: Prieto
authors.forename: Ivan
authors.initials: I
authors.lastname: Sosa
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gregori
authors.forename: Manuel
authors.initials: M
authors.lastname: Gascón
authors.forename: Guillermo C
authors.initials: GC
authors.lastname: Couto
mesh_terms: D000818:Animals; D003287:Contrast Media; D004283:Dog Diseases / Q000151:congenital / Q000000981:diagnostic imaging*; D004285:Dogs; D006325:Heart Atria / Q000000981:diagnostic imaging; D006493:Heparin; D045423:Microbubbles / Q000662:veterinary; D011168:Portal System / Q000002:abnormalities / Q000000981:diagnostic imaging*; D012965:Sodium Chloride; D014463:Ultrasonography / Q000379:methods / Q000662:veterinary; D014684:Venae Cavae / Q000000981:diagnostic imaging
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D006493:Heparin