Maybe portal thrombosis is more frequent then we think.....

Veterinary Radiology & Ultrasound, 2020

Author

Obi Veterinary Education
August 13, 2025

John M. French, David C. Twedt, Sangeeta Rao, Angela J. Marolf

Background
Computed tomographic angiography (CTA) is increasingly used for diagnosing acute pancreatitis in dogs and assessing disease severity. In humans, pancreatic necrosis typically appears on CTA within 48 hours of clinical signs, and repeat CTA is performed to monitor disease progression. However, the necessity of repeat CTA in dogs remains unclear. This study aimed to determine whether serial CTA provides additional diagnostic value in dogs with acute pancreatitis.

Methods
A prospective longitudinal study was conducted on 11 dogs with acute pancreatitis. CTA was performed at the time of hospitalization and repeated 3–5 days later. Imaging evaluations focused on pancreatic size, contrast enhancement, and peri-pancreatic tissue changes, including fat stranding and portal vein thrombosis. Statistical analyses compared initial and repeat CTA findings.

Results
All dogs exhibited pancreatic enlargement and heterogeneous contrast enhancement on initial CTA, with peri-pancreatic fat stranding in 73% of cases. Portal vein thrombosis was observed in 55%. The only statistically significant difference between initial and repeat CTA was improvement in fat stranding (P = .045). No significant changes were detected in pancreatic size, contrast enhancement, or presence of portal vein thrombosis.

Limitations
The small sample size and exclusion of dogs with worsening disease may have introduced bias. Additionally, the study did not assess long-term outcomes or compare CTA findings with histopathology.

Conclusions
Initial CTA is sufficient for diagnosing and evaluating acute pancreatitis in dogs. Repeat CTA within 3–5 days does not provide additional diagnostic value unless clinical signs worsen. These findings suggest that routine follow-up CTA is unnecessary in stable patients.

A, Initial CTA, venous phase, dorsal plane reconstruction (window width 450, window level 90). The pancreas (P) is heterogeneously contrast enhancing with surrounding mesenteric changes (arrow). Note the portal vein thrombus (arrowhead). B, Repeat CTA (3 days later), CTA, venous phase, dorsal plane reconstruction (window width 450, window level 90). The pancreas continues to be heterogeneously contrast enhancing (P) but has better defined margins. The mesenteric changes have improved (arrow). Note the continued presence of the portal vein thrombus (arrowhead). C, Initial CTA of same patient, delayed phase, transverse plane image (window width 450, window level 90). Note the mesenteric changes (arrows) surrounding the heterogeneously contrast enhancing pancreas (P). D, Repeat CTA, delayed phase, transverse plane image (window width 450, window level 90). Note the improved mesenteric changes (arrow) surrounding the pancreas (P)

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