Multiple acquired portosystemic shunts in a cat secondary to chronic diaphragmatic rupture

Abstract

Case summaryA cat with a chronic diaphragmatic rupture presented with neurological signs, including twitching and focal seizures. Blood ammonia level was markedly elevated and therefore neurological signs were thought to be related to hepatic encephalopathy. Exploratory laparotomy revealed that the left lateral and medial liver lobes were herniated into the thorax and multiple acquired portosystemic shunts (MAPSS) were present. The hernia was reduced and the diaphragm repaired. Neurological signs gradually resolved following surgery and 1 year postoperatively the cat was clinically normal, was not on any medication and had no evidence of hepatic dysfunction.Relevance and novel informationThis is the first report of a chronic diaphragmatic rupture leading to MAPSS in a cat.

Peripartum clinical manifestations of a mesentericorenocaval shunt in a Burmese cat

“…Described associations with portal hypertension include hepatic fibrosis, arteriovenous fistulas, chronic diaphragmatic hernia, pathological portal vein occlusion, portal vein hypoplasia and after PSS attenuation, none of which were identified in our patient. 14 , 15 , 17 – 19 The heritability of feline congenital PSSs has yet to be established, with most breed representations based on increased prevalence within published work. 20 Canine breed studies, however, support a familial digenic, tri-allelic trait of PSSs in Irish Wolfhounds, whereas affected Cairn Terriers displayed a polygenic autosomal inheritance pattern.…”

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

“…The prevalence of acquired portosystemic shunting in cats as a result of portal hypertension is low and only occasional reports exist. 35-42 This may be at least in part attributable to the relatively low prevalence of cirrhosis in this species, which is a common cause of acquired shunts in the dog. 39 Acquired shunts have been reported to occur in cats in association with several conditions including hepatic fibrosis, 39,41 arterioportal fistulae, 37,43 portal vein thrombosis 37 and chronic diaphragmatic herniation, 40 and also as a sequela to surgical attenuation of a congenital PSS.…”

“…Acquired shunts can take the form of one or more plexuses of small tortuous vessels in the retroperitoneal space close to one or both kidneys or between the portal vein and CVC (Figure 7). 39,40 A peritoneal effusion of variable volume is also commonly found in cats with acquired PSSs. 39…”

“…Acquired shunts can take the form of one or more plexuses of small tortuous vessels in the retroperitoneal space close to one or both kidneys or between the portal vein and CVC ( Figure 7). 39,40 A peritoneal effusion of variable volume is also commonly found in cats with acquired PSSs. 39 The presence on ultrasound of an acquired shunt taking the form of a solitary abnormal vessel containing hepatofugal flow that originated from the portal vein close to the splenic vein has also been described in two cats with clinical signs of hepatic encephalopathy.…”