Hepatobiliary and pancreatic: Commentary

Abstract

Journal of Gastroenterology and HepatologyVolume 16, Issue 7 p. 824-824 Free Access Hepatobiliary and pancreatic: Commentary First published: 21 December 2001 https://doi.org/10.1046/j.1440-1746.2001.2525b.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat INTERPRETATION OF FIGS 1 AND 2 (SEE PAGE 821) When viewed with B-mode, the vessel-like structure ran parallel to the right branch of the portal vein (Fig. 1). Between the two vessels, a small portion of liver parenchyma was identified and both vessels seemed to communicate with each other. Power Doppler imaging (PDI) showed blood flow signals inside both vessels, and the two streams of blood, which did not communicate with the hepatic veins, were connected at the two orifices (Fig. 2). Furthermore, color Doppler imaging was performed. It portrayed a finding similar to PDI and the directions of blood flow were the same (Fig. 3). Figure 3Open in figure viewerPowerPoint Color Doppler imaging showed the blood flow direction in the additional vessels is hepatopetal. The additional vessel discharged blood from the main branch of the portal vein and then flowed into the right branch of the portal vein. DIAGNOSIS: DUPLICATED PORTAL VEIN To obtain more detailed information and confirmatory notes on duplicated portal vein diagnosis, dynamic CT scan and MRI were performed. Both procedures manifested similar findings of a duplicate branch of the right portal vein (Fig. 4). Figure 4Open in figure viewerPowerPoint A duplicated right portal vein was confirmed by the use of a CT scan. Anomalies of the portal venous system occur infrequently.1–3 They are usually congenital and appear to have no clinical significance. Although insignificant, they are sometimes accompanied by other important congenital abnormalities. Therefore, knowledge of the presence of this anomaly, ‘a duplicated portal vein’, may be useful. It is unnecessary for the simple duplicated portal vein to be treated. However, the diagnosis must be differentiated from an intrahepatic portosystemic shunt, an aneurysm of the portal vein and an intrahepatic arteriovenous fistula that may cause severe complications.1–3 The intrahepatic portosystemic shunt connects the portal with the hepatic vein.1 Its location and blood flow signal pattern are quite different from the duplicated portal vein. An aneurysm of the portal vein appears as a cystic-like or shuttle-like protuberance in certain parts of the portal vein.2 For the ultrasound diagnosis of intrahepatic arteriovenous fistula, the spectral waveform analysis is very useful.3 In conclusion, although duplicated portal vein is extremely rare, it is important to detect this kind of anomaly in screening for other intrahepatic vascular abnormalities. References 1 Kudo M. Intrahepatic portosystemic venous, shunt in liver cirrhosis: is it congenital or acquired? AJR 1993; 160: 421– 2. 2 Vine HS, Sequeira JC, Widrich WC, Sack BA. Portal vein aneurysm. AJR 1979; 132: 557– 60. 3 Foley WJ, Turcotte JD, Hoskins PA, Brant RL, Ause RG. Intrahepatic arteriovenous fistulas between the hepatic artery and portal vein. Ann. Surg. 1971; 174: 849– 55. Volume16, Issue7July 2001Pages 824-824 FiguresReferencesRelatedInformation