A “spaghetti sign” in feline abdominal radiographs predicts spleno‐systemic collateral circulation

Abstract

A well-defined, tortuous, and tubular soft tissue opaque structure has been observed within the left mid abdominal cavity in digital radiographs of some cats. Authors hypothesized that this radiographic "spaghetti sign" is a predictor for spleno-systemic collateral circulation. The purpose of this multicenter, retrospective, descriptive study was to further characterize radiographic "spaghetti signs" in a group of cats and compare these signs with results of ultrasonography or computed tomography (CT). A multiinstitutional database was reviewed for radiographic reports describing the presence of a tubular tortuous structure within the left abdominal cavity of feline patients. Patients were included if additional abdominal ultrasound or CT studies were available.Imaging studies and medical records were retrieved and reviewed by a board-certified veterinary radiologist, and characteristics were recorded. Eighteen cats met the inclusion criteria. The presence of a tortuous vessel consistent with spleno-systemic collateral circulation was observed by ultrasonography or CT examinations in all patients with a "spaghetti sign" on abdominal radiographs. All patients were spayed females. One cat showed ultrasonographic imaging features consistent with portal hypertension. In conclusion, findings supported the hypothesis that a radiographic "spaghetti sign" is a predictor of spleno-systemic collateral circulation in feline patients and should be distinguished from other signs such as focal loss of serosal detail or a space occupying lesion.

A Sphaghetti Sign in the Abdominal Radiograph Consistent with Spleno-Systemic Shunts in a Cat

“…Commonly known, when portosystemic shunts are suspected in domestic animals, abdominal ultrasonography or computed tomography angiography (CTA) scan should be performed to confirm portal collaterals. However, abnormal shunt vessel can be seen on the plain radiograph in the cases of cats (1). Therefore, when there is a twisted tubular soft tissue opacity at the retroperitoneal region caudal to kidney, spleno-systemic shunts should be taken into account regarding the differential diagnosis.…”

Feline abdominal ultrasonography: what’s normal? what’s abnormal? Hepatic vascular anomalies

“…48 The typical radiographic appearance is that of a well-defined, tortuous, tubular structure of soft tissue opacity within the left mid-abdominal cavity, lateral to the left kidney and caudal to the spleen. 48…”

“…Splenosystemic shunts have additionally been observed in abdominal radiographs of cats and create what is now referred to as a 'spaghetti sign'. 48 The typical radiographic appearance is that of a well-defined, tortuous, tubular structure of soft tissue opacity within the left mid-abdominal cavity, lateral to the left kidney and caudal to the spleen. 48 e f Like ultrasound, computed tomography angiography (CTA) is a non-invasive diagnostic modality frequently used for the detection of shunts in both human and veterinary medi-cine.…”

“…48 The typical radiographic appearance is that of a well-defined, tortuous, tubular structure of soft tissue opacity within the left mid-abdominal cavity, lateral to the left kidney and caudal to the spleen. 48 e f Like ultrasound, computed tomography angiography (CTA) is a non-invasive diagnostic modality frequently used for the detection of shunts in both human and veterinary medi-cine. 49 However, unlike ultrasound, which only enables a small region of the abdomen to be imaged at any given time, CTA provides the user with a global overview of the shunt(s) within the abdomen, allowing shunt anatomy, course and position relative to other organs and vessels to be accurately determined and easily understood (Figure 8).…”