Transhepatic Embolization of Congenital Intrahepatic Portosystemic Venous Shunts with Associated Aneurysms.

Kalyan Paudel,Eric K. Hoffer

doi:10.1155/2015/375086

Abstract

Intrahepatic shunts between the portal and systemic venous systems with associated aneurysms are extremely rare. A middle aged woman presented with hepatic encephalopathy and was found to have two intrahepatic portosystemic venous shunts with associated aneurysms. Diagnosis was made by duplex ultrasound and was confirmed with contrast enhanced MRI. Treatment was performed percutaneously with an Amplatzer vascular plug.

Highlights

Intrahepatic shunts between the portal and systemic venous systems with associated aneurysms are extremely rare
Stringer described four major different varieties of congenital portosystemic venous shunts in six children seen during a 10year period, with reference to anatomy of the shunt which was determined by imaging studies and surgery [1]
Doppler US: presence of vascular structures connecting a portal branch to a hepatic vein with or without aneurysm formation

Summary

Introduction

Intrahepatic shunts between the portal and systemic venous systems with associated aneurysms are extremely rare. A 45-year-old woman presented with right upper quadrant abdominal pain, swelling, and symptoms consistent with encephalopathy (confusion, altered level of consciousness). Her RUQ pain had become more intense and continuous over the prior few months, prompting her to seek medical treatment. Multiplane, multisequence magnetic resonance imaging (MRI) of the abdomen with and without contrast revealed two intrahepatic portohepatic venous shunts, each associated with an aneurysm (Figures 3(a), 3(b), 4(a), and 4(b)). These were thought to be congenital in origin

Results

Discussion

Conclusion