Extrahepatic Portal Vein Aneurysm Research Articles

Extrahepatic portal vein aneurysm in which the acute thrombogenic process triggered by trauma confirmed by abdominal ultrasonography: a case report.

Extrahepatic portal vein aneurysm (PVA) is a rare condition in which the extrahepatic portal vein is partially dilated into a sac-like or spindle-like shape. Usually, patients are followed, but surgery is considered in cases of rupture, thrombus, or enlargement. We report a case of thrombus formation in an extrahepatic portal vein aneurysm following trauma that resulted in regression of the aneurysm and extrahepatic portal vein occlusion. Immediately after the trauma, ultrasonography showed moderately hyperechoic structures and comet signs along the vessel wall of the aneurysm and turbulent blood flow in the aneurysm, like in a whirlpool. There were floating point-like echogenic features, which were presumed to be microthrombi. In other words, the trauma might have triggered Virchow's triad: changes in the vessel wall, changes in blood properties, and blood stagnation. This is a valuable case in which ultrasonography imaging revealed interesting changes during the thrombus formation process inside an extrahepatic portal vein aneurysm. The aneurysm's size was reduced by thrombus-induced organization, but the main trunk of the portal vein became deficient in blood flow, resulting in extrahepatic portal vein occlusion. This case is suggestive of the mechanism of extrahepatic portal vein occlusion.

Extrahepatic portal vein aneurysm identification during cholecystectomy.

Extrahepatic portal vein aneurysm identification during cholecystectomy.

Extra-hepatic portal vein aneurysm diagnosed by EUS.

Extra-hepatic portal vein aneurysm diagnosed by EUS.

A Duodenal Gastrointestinal Stromal Tumor with Extrahepatic Portal Vein Aneurysm that was Difficult to Diagnose from a Pancreatic Tumor—A Case Report—

症例は55歳，女性．健診にて胆嚢ポリープを指摘され当院へ紹介受診となった．CT検査およびMRI検査で膵頭部右縁壁に石灰化を認め，腫瘤内尾側に充実成分を伴う30mm大の嚢胞性腫瘤を認めた．また，上腸間膜静脈と脾静脈の合流部近傍に29mm大の門脈瘤を認めた．EUSでは膵鉤部に低エコーを示す石灰化を伴う腫瘤として認められたが，FNAでは確定診断は得られなかった．画像所見よりSPNやP-NETを疑い，幽門輪温存膵頭十二指腸切除術を施行した．門脈瘤に対しては増大傾向を認めなかったため，切除は施行しなかった．術後病理診断では，腫瘤は十二指腸の固有筋層内に位置していた．腫瘤部は短紡錘形核と好酸性の細胞質を有する紡錘形細胞が束状，錯綜配列を示し，充実性胞巣を形成していた．c-kit陽性であり最終診断は十二指腸GISTであった．

Clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm

Objective To investigate the clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm. Methods The method of retrospective descriptive study was conducted. The clinical data of 1 patient with extra-hepatic portal vein aneurysm who was admitted to the Guangzhou General Hospital of Guangzhou Military Command of PLA in May 2014 were collected. The patient suffered from dull pain in his epigastrium, with no obvious causative factors. The patient recieved abdominal B-ultrasound, CT scans abdominal and superior mesenteric artery, angiographies after admission in May 2014, and was diagnosed as with extra-hepatic portal vein aneurysm. The preventative surgical resection was selected according to the patient′s individual health status. Extra-hepatic portal vein aneurysm resection was conducted under the guidance of intraoperative ultrasonography after abdominal exploration. A double-cavity drainage tube was placed in the venturis hole when portal vein aneurysm was dissected and removed. Then the abdomen was closed. The patient received regular perioperative management. The operation time, volume of intraoperative blood loss, time for diet recovery, time of drainage tube removal, postoperative complications, results of laboratory tests, results of imaging findings, healing of incision, time of postoperative discharge from hospital, results of pathologic examination and follow-up were observed. Follow-up using outpatient examination or telephone interview was performed to detect the inspect status of portal vein and inspect recurrence of portal vein aneurysm by abdominal B-ultrasound and CT examinations till December 2014. Results The patient underwent successful extra-hepatic portal vein aneurysm resection. The operation time was 85 minutes and the volume of intraoperative blood loss was around 150 mL. The patient gradually returned to normal diet and self-care ability at postoperative day 3, and the abdominal drainage tube was removed at postoperative day 3. No postoperative complications including hemorrhage, portal vein thrombosis and dysfunction of liver were detected after operation. There were normal levels of blood routine and blood biochemical test. Postoperative B-ultrasound examination showed smooth blood flow in portal vein and the abdominal blood vessel CT angiography presented clear image of the portal vein, with smooth blood flow and normal lumen. The surgical incision recovered very well and the patient was discharged from hospital at postoperative day 9. Results of postopeartive pathologic examination showed that there were cystic-like tissues with simple squamous epithelium cells on the interior, the wall of which consisted of smooth muscle was in accordance of the structure of vein. The patient didn′t receive any other special treatment or take medicines postoperatively. The patient had good physical health and can take care of himself during six-month follow-up, without narrow portal vein, recurrence of portal vein aneurysm and other complications. Conclusion Preventative surgical resection is safe and feasible for extra-hepatic portal vein aneurysm, with a good efficacy. Key words: Portal vein aneurysm, extra-hepatic; Surgical procedures, operative; Preventability; Portal vein aneurysm resection

A rare case of huge intrahepatic portal vein aneurysm

Introduction: Our case was incidentally diagnosed large aneurysm of the main portal vein. The incidence of intrahepatic and extrahepatic portal vein aneurysms (PVAs) is not clear. Portal vein aneurysm usually occurs at the junction of the superior mesenteric vein and splenic veins or at the hepatic hilus at the bifurcation of the right and left portal veins [1]. Case Report: Color Doppler and contrast-enhanced dynamic computed tomography scan and computed tomography angiography clearly showed a well-circumscribed, 44x34 mm intrahepatic portal vein aneurysm. Conclusion: The aim of this study is to evaluate the imaging features of portal vein aneurysm.

Peripancreatic Enhancing Lesion in a Cirrhotic Patient

Question: A 74-year-old white man with a history of decompensated alcoholic liver disease was referred to our clinic for further management of his cirrhosis. The patient initially presented to an outside hospital 2 months prior with increasing abdominal girth and confusion. Small, nonbleeding esophageal varices were visualized on upper endoscopy. Doppler ultrasonography revealed a portal vein thrombus with cavernous transformation. The patient was initiated on warfarin. He presented to us for a second opinion. Physical examination revealed an elderly, ill-appearing gentleman with anicteric sclera, shifting dullness and bilateral lower extremity edema. Laboratory testing was notable for a total bilirubin of 0.8 mg/dL, alanine and aspartate aminotransferases 190 and 150 U/L, respectively, and alkaline phosphatase 1000 U/D. International Normalized Ratio was prolonged (on warfarin) at 4.2; creatinine was 1.1 mg/dL and albumin 3.2 g/dL. Triphasic computed tomography of the abdomen and pelvis demonstrated a large peripancreatic lesion enhancing on portal venous phase with resultant mass effect on adjacent structures (Figure A). What is the diagnosis? Look on page 324 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Triphasic computed tomography of the abdomen reveals an 8.2 × 6.5-cm portal vein aneurysm containing subacute thrombi. Compression of the remnant thrombosed portal vein demonstrates mass effect from the aneurysm (Figure A). Cavernous transformation of the liver secondary to portal vein thrombosis can be seen distal to the aneurysm (Figure B). Coronal and sagittal views further demonstrate the extent of the aneurysm (Figures C, D). Portal vein aneurysm is a rare clinical entity that mainly occurs at bifurcations and confluences of the portal venous system, both intra- and extrahepatically. In patients without preexisting liver disease, it may result from congenital malformations, such as intrinsic weakness of the vein wall or diverticular remnant of a primitive portal precursor.1Lau H. Chew D.K. Belkin M. Extrahepatic portal vein aneurysm: a case report and review of the literature.Cardiovasc Surg. 2002; 10: 58-61Crossref PubMed Scopus (0) Google Scholar In cases of acquired portal vein aneurysm, portal hypertension secondary to cirrhosis is the most frequently reported cause. Portal hypertension initially leads to compensatory medial hypertrophy that is eventually replaced by fibrous tissue with weak tensile strength.2Rafiq S.A. Sitrin M.D. Portal vein aneurysm: case report and review of the literature.Gastroenterol Hepatol. 2007; 3: 296-298PubMed Google Scholar However, portal vein aneurysms are still rare in patients with known cirrhosis, suggesting that an existing congenital abnormality may be present for portal hypertension to result in aneurysmal dilation.1Lau H. Chew D.K. Belkin M. Extrahepatic portal vein aneurysm: a case report and review of the literature.Cardiovasc Surg. 2002; 10: 58-61Crossref PubMed Scopus (0) Google Scholar Because most patients are asymptomatic, portal vein aneurysms are generally found incidentally on abdominal imaging. Conservative management with serial imaging is appropriate for small aneurysms in asymptomatic patients without concomitant portal hypertension or cirrhosis. Complications from portal vein aneurysm include thrombosis, rupture, and symptoms related to compression on adjacent organs such as the common bile duct, duodenum, and vena cava. Rupture of portal vein aneurysm is unusual because of low portal venous pressure, but the risk of rupture does increase in the presence of portal hypertension. Patients with portal hypertension and portal vein thrombosis may benefit from surgical shunts to reduce portal pressure and prevent progressive dilation of the aneurysm.3Brock P.A. Jordan P.H. Barth M.H. et al.Portal vein aneurysm: a rare but important vascular condition.Surgery. 1997; 121: 105-108Abstract Full Text PDF PubMed Scopus (69) Google Scholar This particular patient had several risk factors for acquired portal vein aneurysm, including decompensated alcoholic cirrhosis with portal hypertension as well as radiographic evidence of chronic pancreatitis. Given the patient's age, multiple comorbidities, and rapid deterioration, it was the family's request not to pursue aggressive measures. His anticoagulation with warfarin was discontinued.

Imaging features and follow-up of large extrahepatic portal vein aneurysm

A 67-year-old man presented at our hospital for routine abdominal imaging studies before planned surgery for lung cancer. He had no obvious abdominal complaints. He had a history of chronic pancreatitis. Physical examination revealed no abnormal findings. Routine blood tests, including liverassociated enzymes, did not show any remarkable findings. We performed ultrasound (US) imaging, which demonstrated a 5.44.3-cm, round-shaped anechoic lesion at the hepatic hilum. Color Doppler US imaging showed bidirectional color due to circular flow within this lesion (A, arrows). Abdominal contrast-enhanced multidetector computed tomography (CT) and CT angiography with three-dimensional reconstructions using maximum-intensity projection (B, white arrow) and volume-rendering technique (Cover) confirmed the diagnosis of a saccular aneurysm at the truncus of the portal vein close to its bifurcation. Pancreatic calcifications were also present (B, black arrow). Complementary magnetic resonance imaging angiography showed the aneurysm with no abnormality of the liver and spleen. Axial maximum-intensity projection reformatted sections demonstrated that right and left branches of portal vein were normal (C, arrows). Thus, our patient was considered to have an acquired extrahepatic portal vein aneurysm (PVA) due to his history and imaging features of pancreatitis. Two years after the diagnosis, the aneurysm had not grown in size. Because our patient had no serious complaints or liver disease, surgical procedures had not been used.

Extrahepatic portal vein aneurysm after liver transplantation in a child: Case report

Portal vein aneurysms are very rare and represent <3% of all venous aneurysms. They can be congenital or acquired. Most patients do not have liver disease at diagnosis. Although uncommon, portal vein aneurysm has been described after liver transplant. We report the case of a six-yr-old girl who presented with an aneurysm of the extrahepatic portal vein after segmental liver transplantation. Because the patient was asymptomatic and owing to its extrahepatic location, this aneurysm has been successfully followed by clinical exam and imaging for four yr.

Extrahepatic portal vein aneurysm

A 29-year-old female presented with intermittent rightupper quadrant abdominal pain. It lasted a few seconds perepisode and was spontaneously alleviated. The frequencywas 1—2 times per day. She had no history of abdominaltrauma or surgery. Physical examination revealed mild ten-derness of the right upper quadrant of abdomen withoutany rigidity. On laboratory tests, no significant abnormalitywas found. Abdominal computed tomography angiographywith volume rendering technique showed a large aneurysminvolving portal vein trunk and superior mesenteric vein,normal liver and spleen, and no ascites (Fig. 1). The max-imum diameter of portal vein aneurysm was 4.4cm, andthat of superior mesenteric vein aneurysm was 3cm. ColorDoppler ultrasound confirmed these above-mentioned find-ings. Upper gastrointestinal endoscopy did not find anyabnormalities. Complication of portal hypertension wasexcluded given the absence of esophageal or gastric varicesand ascites. Thus, a diagnosis of extrahepatic portal veinaneurysm without significant portal hypertension was estab-lished. The patient was discharged with regular follow-up.

Extrahepatic portal vein aneurysm after orthotopic liver transplantation: a case with 9-year ultrasound observations.

We report a case of extrahepatic portal vein aneurysm (PVA) in the late postoperative period after orthotopic liver transplantation (OLT). A 46-year-old man underwent OLT in 2001 for treatment of hepatitis B virus-induced cirrhosis and received ultrasound follow-up for 9years. The long-term ultrasound observations showed that the diameter of the main portal vein had progressively increased from 12mm in 2001 to 34mm in 2007, and then remained at 34mm from 2007 to 2010. The patient did not show any symptoms or complications that required surgical treatment during the clinical follow-up. Our case suggests that PVA after OLT can remain without a sign of deterioration for a long time, and careful observation by ultrasound may be one of the options in the clinical management.

Computed tomography findings in portal vein aneurysm of dogs

In this retrospective study, the appearances of extrahepatic and intrahepatic portal vein aneurysms (PVAs) in dogs were evaluated using multidetector computed tomography (CT). Data from 3060 dogs that underwent abdominal CT were reviewed for focal portal vein dilatation. PVAs were detected in 15/3060 (0.49%) dogs. The bodyweights of dogs with PVAs were significantly higher than the bodyweights of dogs without aneurysms (P=0.0001). Male sex was also significantly associated with PVAs (OR=6.23). Boxers were predisposed to the development of PVA (OR=11.88). Extrahepatic PVAs were always located in the portal vein at the level of the gastroduodenal vein insertion and were saccular in 10/15 dogs and fusiform in 5/15 dogs. One dog had an additional intrahepatic aneurysm of the umbilical part of the left intrahepatic portal branch. No dogs had clinical signs related to the PVA(s), although one dog developed a portal vein thrombosis in the site of the aneurysm.

Extra-hepatic portal vein aneurysm: A case report, overview of the literature and suggested management algorithm

INTRODUCTIONPortal venous aneurysms are a rare finding. The reported incidence is on the rise with increasing use of modern imaging techniques in clinical practice. However, there is still much to be elicited regarding their aetiology, natural history, and management. PRESENTATION OF CASEAn 80-year-old woman presented with abdominal pain and nausea. Investigations showed a hypoechoic area in the region of the head of pancreas on ultrasound, which was found to be a portal venous aneurysm on CT. In view of her multiple comorbidities, a conservative approach was taken. DISCUSSIONPortal venous aneurysms represent approximately 3% of all venous aneurysms with a reported prevalence of 0.43%. They may be congenital, due to failure of complete regression of the right vitelline vein, or acquired secondary to portal hypertension. The primary presentation of portal vein aneurysm is abdominal pain, followed by incidental detection on imaging, with a minority of patients presenting with gastrointestinal bleeding. Complications of PVA include thrombosis, biliary tract obstruction, inferior vena cava obstruction, and duodenal compression. On the whole PVAs are stable and have a low risk of complications with 88% of patients showing no progression of aneurysm size or complications on subsequent follow up scans. CONCLUSIONWe recommend that portal venous aneurysms be assessed using colour Doppler ultrasonography in the first instance with CT scans reserved for indeterminate cases or symptomatic patients. Due to the slow progression of such aneurysms, surgery is recommended only for symptomatic patients or those with complications secondary to portal venous aneurysms.

増大傾向を示し手術を施行した肝外門脈瘤の1例

増大傾向を示し手術を施行した肝外門脈瘤の1例

Outcome With Surgical Repair of Extrahepatic Portal Vein Aneurysms

Extrahepatic portal vein aneurysm is a rare clinical entity. The two most common locations for aneurysmal formation are at the confluence of the superior mesenteric vein (SMV) and the splenic vein, and at main portal vein trunk, just above the SMV-splenic vein confluence. In this article, two cases of extrahepatic portal vein aneurysm and their surgical treatment are presented. One is a saccular aneurysm located at the truncus of the portal vein; the other is a fusiform aneurysm at the confluence of the superior mesenteric vein and the splenic vein.

Thrombosed congenital extrahepatic portal vein aneurysm in an infant

Extrahepatic portal vein aneurysm is extremely rare in infants. We report an infant with thrombosed congenital extrahepatic portal vein aneurysm demonstrated on US and CT. Follow-up US after 16months showed complete regression of the portal vein aneurysm.

Erratum to: Thrombosed extrahepatic portal vein aneurysm: report of two cases and review of the literature

Erratum to: Thrombosed extrahepatic portal vein aneurysm: report of two cases and review of the literature

A case report of extrahepatic portal vein aneurysm with thrombosis.

Extrahepatic portal vein aneurysm (PVA) is very rare with only 17 previously reported cases. Methods of treatment include resection, thrombectomy, and portal venous decompression. We report herein the first case of large PVA with thrombosis which has been managed without surgical treatment over a long period. A PVA was detected in a 78-year-old woman by abdominal ultrasonography. Computed tomography revealed an aneurysm of 6 cm in a diameter in the porta hepatis. Portal venography showed obstruction of the portal vein and developed collateral vessels around the aneurysm. Since the patient had no symptoms of portal hypertension, we decided to carefully manage her clinical course without surgical treatment. At present, this patient is healthy and has developed no complications over the 5 years since leaving our hospital. This case suggests that surgical treatment is not required for PVA without portal hypertension.

Ultrasonography and 3D-CT Follow-Up of Extrahepatic Portal Vein Aneurysm: A Case Report

Extrahepatic portal vein aneurysm is a rare disorder. From 1956 to 2008, we found only 43 published English-language reports, including 67 cases, using Pub Med. We report a case of a 77-year-old woman who had complaints of lower abdominal fullness and residual urine. We performed ultrasonography (US), which demonstrated a congenital extrahepatic portal vein aneurysm. She had no obvious symptoms of the extrahepatic portal vein aneurysm. She had undergone gastrectomy without blood transfusion for gastric ulcer more than 20 years ago. Physical examination revealed no abnormal findings. US revealed a 2.2 × 1.8 cm, round shaped hypoechogenic lesion at the hepatic hilum. Color Doppler US showed bidirectional colors due to circular flow within this lesion. 3D-CT and CT angiography demonstrated that the saccular aneurysm at the hepatic hilum was 3.0 cm in diameter and was enhanced equal to that of portal vein.Twenty-six months after the diagnosis, the aneurysm had not grown in size. Since our patient had no serious complaints or liver disease, surgical procedures had not been employed. US and 3D-CT are noninvasive diagnostic techniques and are helpful in the diagnosis and follow-up of extrahepatic portal vein aneurysms.

Huge extrahepatic portal vein aneurysm as a late complication of liver transplantation

A 60-year-old male underwent orthotopic liver transplantation because of hepatitis C virus related cirrhosis. After 12 d, the patient underwent re-transplantation due to primary graft non function. One year later the patient developed a thrombosis of the main portal vein needing a surgical revision. After 11 years the patient was operated on because of a clinical picture of intestinal occlusion. As an incidental finding, a large aneurysm of the main portal vein was diagnosed. The incidence of intra- and extrahepatic Portal vein aneurysms (PVAs) is not clear. To the best of our knowledge, only one case of intrahepatic PVA in a liver transplant has been reported in the literature. In addition, we have found no documented cases of extrahepatic PVAs in liver transplanted patients.