A canine case of multiple intrahepatic portosystemic shunts

An elderly, spayed female Maltese dog (10 years 3 months, 2.2 kg) presented with hyporexia, weight loss, polydipsia, and a staggering gait. Serum biochemistry analysis revealed increased aspartate aminotransferase, alanine transaminase, ammonia (226 μg/dL), and fasting total bile acids (130 μmol/L). Contrast-enhanced CT showed multiple clusters of contrast enhancement within the hepatic parenchyma; however, discrete shunt vessels could not be clearly identified, and a definitive diagnosis could not be established based on CT alone. Intraoperative jejunal venous portography revealed numerous microvascular clusters connecting portal branches to the hepatic vein and caudal vena cava. The portal pressure was 7 mmHg. Based on these findings, multiple intrahepatic portosystemic shunts (MIPSS) were diagnosed, and medical management was selected.