Ectopic kidneys and vascular anomalies in a dog

JSAP Images in SA Practice

Author

Ryan Appleby
April 09, 2024

Bilateral simple ectopic kidney with congenital portosystemic shunt and caudal vena cava with azygos continuation in a dog

Background

This case study involves a 1-year-old female Shiba Inu diagnosed with a portosystemic shunt (PSS). Despite being in good physical condition, the dog exhibited hyperammonemia, low blood urea nitrogen, and elevated levels of serum total bile acid, aspartate aminotransferase, and alanine aminotransferase.

Methods

A 16-slice multidetector CT scanner was used for imaging to determine the presence of a portosystemic shunt. The imaging focused on the abdominal and thoracolumbar regions to identify abnormalities in the vascular and renal systems.

Results

The CT imaging revealed several anomalies:

- Absence of the caudal vena cava (CVC) caudal to the hepatic vein, with systemic veins normally connected to the CVC anastomosed with the azygos vein.

- Two shunt vessels observed from the left gastric vein, anastomosing to the azygos and phrenic veins.

- Ectopic positioning of both kidneys; the left kidney was located on the left side of the bladder at the level of L6-L7, and the right kidney was found caudal to the bladder in the pelvic cavity. Both kidneys were correctly connected to the bladder via their ureters, and their arteries and veins anastomosed to the external iliac arteries and common iliac vein, respectively.

- Multiple fusions of vertebrae in the thoracolumbar spine were also observed.

From these findings, diagnoses of bilateral simple ectopic kidney, spinal synostosis, congenital PSS, and segmental aplasia of the CVC with azygos continuation were made.

Limitations

The paper did not delve into the potential long-term impacts of these conditions on the dog's health or the effectiveness of the chosen symptomatic treatment. The decision not to pursue surgical treatment for PSS, based on the owner's preference, limits the understanding of potential outcomes or improvements that could have been achieved.

Conclusions

This case highlights the complexity of diagnosing and managing congenital anomalies in dogs, particularly when multiple systems are involved. The findings emphasize the importance of comprehensive imaging in identifying the extent of such anomalies and guiding the approach to management. The symptomatic treatment with lactulose for PSS reflects a conservative approach in cases where surgical options are not pursued.

CT imaging of this case. The post contrast sagittal maximum intensity projection (MIP) image (soft tissue window) (A): the left kidney was located on the level of L6-7, and the right kidney was located on the level of S1. All veins caudal to the hepatic vein that would normally anastomose with the CVC were anastomosed with azygos vein. The volume rendered reconstruction image of left side view (B): green region; shunt vessel, blue region; systemic vein, yellow region; portal vein, pink region; aorta and heart. The post contrast dorsal MIP image of right kidney (soft tissue window) (C): the right renal veins anastomosed to the right common iliac vein; yellow arrowhead; the right common iliac vein, red arrowhead; the right renal veins. The post contrast transverse MIP image of left kidney (soft tissue window) (D): the left renal veins anastomosed to the left common iliac vein; yellow arrowhead; the left common iliac vein, red arrowhead; the left renal veins. The volume rendered reconstruction image of ventral side view (E): blue region; vein, pink region; aorta. Sagittal multi-planer reconstruction image of thoracolumbar spine (bone window)

How did we do?

Login or Subscribe to participate in polls.

Disclaimer: The summary generated in this email was created by an AI large language model. Therefore errors may occur. Reading the article is the best way to understand the scholarly work. The figure presented here remains the property of the publisher or author and subject to the applicable copyright agreement. It is reproduced here as an educational work. If you have any questions or concerns about the work presented here, reply to this email.