Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause

Abstract

B-mode and color Doppler sonography were used to assess the incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunt in adults without detectable cause. A total of 25,579 adults without potential cause of intrahepatic portosystemic venous shunt were screened using B-mode sonography. Suspicion of shunt was confirmed by color Doppler sonography. Patients with shunt were followed up with sonography at 6- to 12-month intervals and received dietary education to prevent the ingestion of extra-large amounts of protein. During each sonography session, the patients were asked to report any experience of consciousness disturbance. Six patients (0.0235%) showed evidence of shunt on color Doppler sonography. Direct communication between a right portal branch and the inferior vena cava was found in 3 patients; a small aneurysm connecting a peripheral portal branch to the hepatic vein was found in the remaining 3 patients. Five patients were followed up (range, 12-60 months) and showed no change in the size of the shunt. None of the patients with shunt reported an experience of consciousness disturbance. The incidence of spontaneous intrahepatic portosystemic venous shunt is extremely low in asymptomatic adult patients. Follow-up and dietary control seen to be suitable for their management.