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We thank Kurtcehajic et al for their profound interest in our article1Jaiswal P. Yap J.E. Attar B.M. et al.Massive asymptomatic extrahepatic portal vein aneurysm.Am J Med. 2017; 130: e383-e386Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar and for raising 2 very interesting points for discussion. Kurtcehajic et al suggested that the etiology of the abdominal pain was unclear and could have been from the portal vein aneurysm itself. The patient only experienced 1 brief and isolated episode of right upper quadrant pain, which we speculate may have been an episode of prolonged biliary colic. The pain she described was not characteristic of any typical abdominal pathology and spontaneously resolved. We did a comprehensive evaluation that was edited out of the original manuscript for the sake of brevity. Pancreatitis was ruled out: she had a lipase level of 23 U/L, and the contrast-enhanced computed tomography (CECT) scan also did not reveal any evidence of pancreatitis. Similarly, cholecystitis was ruled out on the basis of her clinical presentation, examination, basic laboratory investigations, and CECT findings. In fact, endoscopy was pursued within 1 week; however, the findings were unremarkable. The pain was reported as being sudden, prolonged, isolated, self-limited, and relieved by a 1-time dose of morphine, which does not seem to be characteristic of pain from a chronic ongoing anatomic variant that has remained stable in size over a surveillance period of 18 months. If the pain was from the portal vein itself, the authors would expect that the patient should have had a more prolonged course of pain or have multiple episodes.2Jin B. Sun Y. Li Y.Q. et al.Extrahepatic portal vein aneurysm: two case reports of surgical intervention.World J Gastroenterol. 2005; 11: 2206-2209Crossref PubMed Scopus (23) Google Scholar, 3Moreno J.A. Fleming M.D. Farnell M.B. Gloviczki P. Extrahepatic portal vein aneurysm.J Vasc Surg. 2011; 54: 225-226Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar However, we were unable to find any specific data on the correlation of portal vein aneurysm and the characteristics or natural history of abdominal pain. Hence we cannot confidently attribute the pain to the portal vein aneurysm. We are unable to explain the etiology of the right upper quadrant pain. We have been managing the patient with serial ultrasound scans for surveillance of the portal vein aneurysm. We sincerely appreciate and respect the commentators for pointing out the association between cholelithiasis and portal vein aneurysm. A possible change in the morphology of the portal vein secondary to long-term history of cholelithiasis and its accompanying irritation is a reasonable explanation for portal vein aneurysm. In the case reported by Fujikawa et al the gallbladder with gallstones was in very close proximity to the aneurysmal saccular dilation at the truncus of the portal vein.4Fujikawa T. Tanaka A. Yoshimoto Y. Enlarged extrahepatic portal vein aneurysm in a non-cirrhotic patient: a therapeutic dilemma.BMJ Case Rep. 2011; 2011Crossref Scopus (6) Google Scholar However, in our patient, on CECT (Figure) we found that the portal vein aneurysm was not on the wall adjacent to the gallbladder, making the aforementioned hypothesis unlikely for the patient's findings. When this patient was first admitted under our care, she did not have any written records of her previous medical care. She reported from memory that a previous ultrasound evaluation showed cholelithiasis, and she was unaware of a portal vein aneurysm. She was unable to provide us information on where this study was performed, so no records were obtained. It is possible and even likely that the portal vein aneurysm may have been present; however, the patient did not report it to us. Additionally, in the absence of any possible risk factor for portal vein aneurysm, such as pancreatitis, cholecystitis, malignancy, trauma, or surgery, we believe it is difficult to attribute the etiology of the portal vein aneurysm to any particular event. We hope this answers the excellent questions raised by Kurtcehajic et al. Role of Cholelithiasis in Development of Portal Vein AneurysmThe American Journal of MedicineVol. 131Issue 3PreviewWe have read with great interest the article by Jaiswal et al,1 which considers massive portal vein aneurysm. Through this letter we would like to draw attention to 2 things. Full-Text PDF