Jackson Blenkinsopp

 

PATIENT: Jackson Blenkinsopp 4yo M Weimeraner

 

HISTORY: Gastrointestinal symptoms previously, recent onset seizures. bloods show mildly elevated liver enzymes but normal BAST

 

Abdominal U/S

SUMMARY:

 

The majority of the small intestinal tract lies outwith the abdomen (within the thorax) as described below. The liver is only visible in the abdomen to the right of midline; the solid tissue described adjacent to the heart may reflect the presence of liver (left lobes) also within the pericardium. There is evidence of vascular congestion of the liver and the abnormal hepatic parenchyma may reflect this; trucut biopsy would be required here to further investigate the cause of the abnormal hepatic parenchyma; other differentials include primary or secondary hepatopathy. Given the normal bile acid stimulation test however, these findings are considered more likely to be secondary to the PPDH than a primary cause of the reported seizures.

LIVER: Abnormal: to the right of midline the liver is visible and is normal to mildly increased in size with regular margins and a diffusely patchy / mottled hypoechogenicity throughout. To the midline and left of midline the liver is not visible within the abdominal cavity and the diaphragm is absent. The portal vein is ‘kinked’ (contributory vessels located cranially) and there is mild vascular distension within the liver.

BILIARY TRACT: Normal

SPLEEN: Normal

LEFT KIDNEY: Normal

RIGHT KIDNEY: Normal

LEFT ADRENAL: Normal

RIGHT ADRENAL: Normal

URINARY BLADDER: Normal

ILIOSACRAL LYMPH NODES: Normal

VISCERAL LYMPH NODES: Normal

STOMACH: Normal pylorus displaced to midline by absence of normal left cranial abdominal structures

SMALL INTESTINES: Abnormal: the duodenum courses caudoventrally and then turns cranially in the caudal abdomen, before coursing through the diaphragmatic defect. the distal ileum reappears through the defect and attaches to the ilecolic junction in the ventrocranial midline.

LARGE INTESTINES: Abnormal: colon runs cranially straight to the ileocolic junction which lies as described above

PANCREAS: Normal

GENITAL TRACT: Not visualised

Echocardiography

SUMMARY

 

There are copious small intestines and suspected liver within the thorax here; the pericardium is seen on the left side with solid tissue between it and the heart; and given the finding of abnormal content within the pericardium and the breed predisposition of Weimeraners to PPDH (pericardioperitoneal diaphragmatic hernia), this is suspected to represent this condition. This is congenital and likely to have been present since birth; patients typically present with GI symptoms +/- respiratory symptoms up to 4 years of age. The heart itself has mild mitral valvular disease with associated mild mitral regurgitation, however there is no chamber dilation / remodelling and this is not currently clinically significant. The relationship of this condition is uncertain (?unlikely) to be related to the reported seizures.

 

B-MODE

 

Comments: the heart is surrounded by small intestines, and to the left side there is a sliver of solid echogenic tissue which contains small hypoechoic regions although no vascular structures are identified within this. The heart itself appears normal with the exception of a mildly thickened mitral valve. Small intestines are present predominantly to the left side and occupy the cranial, mid and caudal thorax.

 

LA:Ao ratio (RPS LA, normal <2.5) 2.4

 

M-MODE

 

Not performed – systolic function altered by administration of sedation

COLOUR DOPPLER

 


mild mitral regurgitation

 

SPECTRAL DOPPLER

Not performed

U/S Guided Samples: Results

Not Applicable.

ECG
Not Applicable.

Endoscopy
Not Applicable.

Other

Not Applicable

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