USE OF^99MTCO TRANS‐SPLENIC PORTAL SCINTIGRAPHY FOR DIAGNOSIS OF PORTOSYSTEMIC SHUNTS IN 28 DOGS

Abstract

Ultrasound-guided percutaneous trans-splenic portal scintigraphy (TSPS) using 99mTcO4(-) has been used to image the portal venous system in normal dogs. Compared with per-rectal portal scintigraphy, it provides higher count density, consistent nuclear venograms of the splenic and portal vein, and significantly decreased radiation exposures. This paper describes the use of TSPS for the diagnosis of portosystemic shunts in 28 dogs. TSPS was performed injecting 70 +/- 28 MBq of 99mTcO4(-) (mean +/- SD) into the splenic parenchyma with ultrasound guidance. A dynamic acquisition at a frame rate of four frames/s for 5 min was initiated after placement of the needle and approximately 2s prior to injection. All dogs had diagnoses confirmed via exploratory laparotomy or ultrasonographic identification of the shunting vessel(s). Three studies (10.7%) were nondiagnostic because of intraperitoneal rather than intrasplenic injection of the radionuclide. Three pathways were recognized on the scintigraphic images: (1) portoazygos shunts--the 99mTcO4(-) bolus traveled dorsally, running parallel to the spine and entering the heart craniodorsally; (2) single portocaval or splenocaval shunts--the 99mTcO4(-) bolus ran from the area of the portal vein/splenic vein junction in a linear fashion toward the caudal vena cava entering the heart caudally; (3) internal thoracic shunt-the 99mTcO4 bolus traveled ventrally along the thorax and abdomen entering the cranial aspect of the heart. Single and multiple shunts were easily distinguished. There were no distinguishing features between single intra and extrahepatic portocaval shunts.

Transdiaphragmatic Approach to Attenuate Porto‐Azygos Shunts Inserting in the Thorax

“…Nine dogs (August 2013 to January 2016) with porto‐azygos shunts diagnosed by trans‐splenic portal scintigraphy using technetium pertechnetate 99mTcO4 underwent a transdiaphragmatic approach for shunt attenuation. All dogs received medical stabilization for an initial (4 week) period before surgery, consisting of a dietary, antimicrobial, and synthetic disaccharide regimen.…”

Unusual haemodynamics in two dogs and two cats with portosystemic shunt - implications for distinguishing between congenital and acquired conditions

“…3) Multiple congenital porto-caval connections in a patient without PH. Although considered a rare phenomenon, multiple CPSS have also been described in dogs (Johnson et al, 1987;Wilson et al, 1997;Morandi et al, 2005;Leeman et al, 2013); in all cases however, large porto-caval or porto-azygous vascular connections were reported without varices nor splenogonadal pattern. Hence, this last hypothesis would redefine the classifications of CPSSs including among these even the left splenogonadal PSS and the porto-caval varices close to the left kidney.…”

Bipartite portosystemic shunt with single insertion: a rare congenital vascular anomaly in a dog

“…Trans-splenic portal scintigraphy has been shown to be more advantageous to per-rectal portal scintigraphy in shunt diagnosis in one study. Identification and differentiation between portoazygos and splencaval/portocaval shunting are reliable but differentiation between single intrahepatic and extrahepatic shunting is not possible (Morandi and others 2005). It is clear that clinicians should always be aware of the possibility that more than one shunt may be present.…”