Secondary (acquired) PSS takes the form of multiple,small extrahepatic vessels in the omentum or retroperi-toneum near the kidneys, which drain directly or indi-rectly into the caudal vena cava
(Figure 1). AcquiredPSS develops in response to chronic portal hyperten-sion, which occurs most often as a result of hepaticfibrosis or cirrhosis.
Breed-associated hepatopathiesmay lead to portal hypertension and acquired PSS inGerman shepherds, American cocker spaniels, Dober-man pinschers, and Labrador retrievers.
Portal hyper-tension may also occur in young dogs secondary tocongenital anomalies, such as portal vein atresia
orhepatic arterioportal fistula.
ROLE OF DIAGNOSTIC IMAGING
The role of diagnostic imaging in dogs with signs of PSS is to determine whether PSS is present, to deter-mine whether the lesion is congenital or acquired, andto assess the severity of the shunting. Also, diagnosticimaging enables preoperative morphologic assessmentof intrahepatic PSS. This is useful because the mor-phology largely dictates which techniques may be usedfor surgical treatment, thereby possibly reducing surgi-cal time. Complications occur commonly during surgi-cal treatment of dogs with intrahepatic shunts, particu-larly if surgery is prolonged because the shunt isdifficult to find.
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Figure 1A—Normal anatomyFigure 1B—Left-divisional shuntFigure 1C—Central-divisional shuntFigure 1D—Right-divisional shuntFigure 1E—Congenital extrahepatic shuntFigure 1F—Acquired extrahepatic shuntFigure 1—
Anatomy of the liver and types of portosystemic shunts.
Hepatic divisions, lobes, and normal pattern of branching of the portal vein (
, caudal aspect;
= caudate lobe;
= left lateral lobe;
= left medial lobe;
= papillary process of caudatelobe;
= quadrate lobe;
= right medial lobe;
= right lateral lobe).
Left-divisional shunt. This arises from a left branchof the PV and drains into the left hepatic vein
via the patent ductus venosus
. The confluence of ductus and LHV isusually dilated and is known as the ampulla (
= caudal vena cava).
Central-divisional shunt. The PV has a relatively straight course into the right medial lobe, where it forms a localized dilation on the ventral aspect of the CVC. The communicationbetween the PV and the CVC is via a foramen
Right-divisional shunt. The shunting vessel passes within the right lat-eral or caudate lobe, sometimes forming a wide loop before draining into the CVC.
Congenital extrahepatic PSS. A singleanomalous vessel connects portal tributaries with the CVC.
indicate direction of blood flow.
Acquired extrahepatic PSS.This often develops secondary to hepatic disease that inhibits blood flow through the liver. Portal tributaries may be dilated. Flowin the portal vein may be hepatofugal
. (A through D were redrawn from Lamb CR: Ultrasonography of portosys-temic shunts in dogs and cats.
Vet Clin North Am Small Anim Pract
28:725–753, 1998; with permission).