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An asymptomatic case with multiple intrahepatic portosystemic venous shunts
Digestive and Liver Disease 43 (2011) e19
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
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An asymptomatic case with multiple intrahepatic portosystemic venous shunts Elife Erarslan a,∗ , I˙ lhami Yüksel a , Volkan Kahveci b , Mehmet Akif Teber b a b
Etlik I˙ htisas Educational and Research Hospital, Department of Gastroenterology, Ankara, Turkey Etlik I˙ htisas Educational and Research Hospital, Department of Radiology, Ankara, Turkey
a r t i c l e
i n f o
Article history: Received 23 February 2011 Accepted 19 April 2011 Available online 15 June 2011
A 35-year-old male patient was admitted for mild abdominal pain. He had no history of operation, medication, or any injury. Physical examination and laboratory results were normal. Portal vein (PV) Doppler ultrasound showed a shunt between middle hepatic vein (HV) and left branch of PV. Angiography of magnetic resonance imaging of the liver revealed aneurysms and shunts between left PV and middle HV (Fig. 1). Three shunts were seen between segment 2 and segment 3 branches of the left PV and the left HV (Fig. 2). This case was compatible with third type that defines a connection between peripheral portal and hepatic veins through an aneurysm [1]. Minimal hepatic encephalopathy is excluded by psychometric tests including trailmaking tests and Wechsler Adult Intelligence Scale. Plasma ammonia level was also normal. Portosystemic venous shunt (PVS), a direct communication between the main PV or its proximal branches and the HV, is a relatively uncommon finding. Intrahepatic spontaneous PVSs are extremely rare and may be due to liver injury, congenital malformations, or collaterals arising as a result of portal hypertension [1]. Intrahepatic PVSs are easily identified with colour Doppler sonography [1]. Usually magnetic resonance imaging is used to confirm the diagnosis when sonography leads to the suspicion of PVS [1]. We here in reported an unusual case presented with asymptomatic multiple PVS’s in the liver that are between left PVs and HVs.
Reference ∗ Corresponding author at: Etlik I˙ htisas Educational and Research Hospital, Department of Gastroenterology, Halil Sezai Erkut Caddesi, Zip code: 06010, Etlik/Ankara, Turkey. Tel.: +90 0312 567 2376; fax: +90 0312 323 4270. E-mail address: [email protected] (E. Erarslan).
[1] Lin ZY, Chen SC, Hsieh MY, et al. Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause. J Clin Ultrasound 2006;34: 22–6.
1590-8658/$36.00 © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2011.04.016
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
An asymptomatic case with multiple intrahepatic portosystemic venous shunts Elife Erarslan a,∗ , I˙ lhami Yüksel a , Volkan Kahveci b , Mehmet Akif Teber b a b
Etlik I˙ htisas Educational and Research Hospital, Department of Gastroenterology, Ankara, Turkey Etlik I˙ htisas Educational and Research Hospital, Department of Radiology, Ankara, Turkey
a r t i c l e
i n f o
Article history: Received 23 February 2011 Accepted 19 April 2011 Available online 15 June 2011
A 35-year-old male patient was admitted for mild abdominal pain. He had no history of operation, medication, or any injury. Physical examination and laboratory results were normal. Portal vein (PV) Doppler ultrasound showed a shunt between middle hepatic vein (HV) and left branch of PV. Angiography of magnetic resonance imaging of the liver revealed aneurysms and shunts between left PV and middle HV (Fig. 1). Three shunts were seen between segment 2 and segment 3 branches of the left PV and the left HV (Fig. 2). This case was compatible with third type that defines a connection between peripheral portal and hepatic veins through an aneurysm [1]. Minimal hepatic encephalopathy is excluded by psychometric tests including trailmaking tests and Wechsler Adult Intelligence Scale. Plasma ammonia level was also normal. Portosystemic venous shunt (PVS), a direct communication between the main PV or its proximal branches and the HV, is a relatively uncommon finding. Intrahepatic spontaneous PVSs are extremely rare and may be due to liver injury, congenital malformations, or collaterals arising as a result of portal hypertension [1]. Intrahepatic PVSs are easily identified with colour Doppler sonography [1]. Usually magnetic resonance imaging is used to confirm the diagnosis when sonography leads to the suspicion of PVS [1]. We here in reported an unusual case presented with asymptomatic multiple PVS’s in the liver that are between left PVs and HVs.
Reference ∗ Corresponding author at: Etlik I˙ htisas Educational and Research Hospital, Department of Gastroenterology, Halil Sezai Erkut Caddesi, Zip code: 06010, Etlik/Ankara, Turkey. Tel.: +90 0312 567 2376; fax: +90 0312 323 4270. E-mail address: [email protected] (E. Erarslan).
[1] Lin ZY, Chen SC, Hsieh MY, et al. Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause. J Clin Ultrasound 2006;34: 22–6.
1590-8658/$36.00 © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2011.04.016