An unusual case of intrahepatic portosystemic venous shunt

Narisha Maharaj,Jaynund Maharajh,Vanesha Naidu,Pumersha Naidoo

doi:10.4102/sajr.v17i2.244

Abstract

Intrahepatic portosystemic venous shunts are rare vascular anomalies that may be detected in asymptomatic patients, given the recent advances in radiological imaging techniques. Accurate shunt evaluation and classification can be performed with ultrasound and multi-detector computed tomography. We report an unusual case of an intrahepatic portosystemic venous shunt with an incidental finding of neurofibroma.

Highlights

A 29-year-old woman with known hypertension and schizophrenia presented with vague abdominal pain
Ultrasound detected a plexus of vascular, serpiginous structures in the porta hepatis anterior to the portal vein, and a provisional diagnosis of hepatic vascular malformation was considered
Doppler ultrasound can confirm the vascular nature of the structures and calculate a shunt ratio

Summary

An unusual case of intrahepatic portosystemic venous shunt

P Naidoo, MB BCh, FCRad Diag (SA); N Maharaj, MB ChB, FCRad Diag (SA); V Naidu, MB ChB, FCRad Diag (SA); J Maharajh, MB ChB, FFRad (D) SA, MMed Rad (D). Intrahepatic portosystemic venous shunts are rare vascular anomalies that may be detected in asymptomatic patients, given the recent advances in radiological imaging techniques. Accurate shunt evaluation and classification can be performed with ultrasound and multi-detector computed tomography. We report an unusual case of an intrahepatic portosystemic venous shunt with an incidental finding of neurofibromata. Ultrasound detected a plexus of vascular, serpiginous structures in the porta hepatis anterior to the portal vein, and a provisional diagnosis of hepatic vascular malformation was considered. Computed tomography (CT) demonstrated a conglomerate of dilated vessels in the region of the porta hepatis with an intrahepatic portosystemic venous shunt, known as a portal hepatic venous shunt, between the right portal vein and the middle hepatic vein (Figs 1a and 1b). Enlarged, scalloped anterior sacral foramina were observed consistent with neurofibromata (Fig. 1c)

Findings

Discussion

Conclusion