Intrahepatic Portosystemic Venous Shunt Research Articles

Asymptomatic Aneurysmal Portosystemic Venous Shunt: A Case Report and Review of the Literature

Spontaneous intrahepatic portosystemic venous shunt (SIPSVS) is relatively rare and not well recognized. Herein, we report 75-year-old female of an aneurysmal portosystemic venous shunt detected by colour Doppler ultrasound in check-up examination. A direct vascular communication between left portal vein and middle hepatic vein was confirmed by CT-angiography. The cause of intrahepatic portosystemic venous shunt is disputed. This abnormality, mainly described in cirrhotic liver and rarely in healthy liver, is usually revealed by hepatic encephalopathy or glycoregulation disorders. However, with improvements in imaging the number of reports of SIPSVS identified incidentally in patients without definite symptoms increasing.

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

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.

INTRAHEPATIC PORTOSYSTEMIC VENOUS SHUNT IN A NEONATAL ROAN ANTELOPE (HIPPOTRAGUS EQUINUS COTTONI)

A 6-day-old, female roan antelope (Hippotragus equinus cottoni) was diagnosed with a single intrahepatic portosystemic venous shunt at necropsy. Clinical signs had included weakness, lethargy, hypothermia, diarrhea, and a weak suckle response. Multiple seizure episodes were associated with hypoglycemia and characterized by vocalization, muscle fasciculations, and disorientation. Hematologic abnormalities included anemia with hypochromasia, anisocytosis, poikilocytosis, and leukopenia with neutropenia and lymphopenia. Serum biochemical abnormalities included elevations in blood urea nitrogen and total serum bile acid concentration. A portosystemic vascular anomaly should be a differential diagnosis for nonthriving, exotic ruminant calves with overt or subtle neurologic signs, persistent hypoglycemia, and/or elevated bile acids. In very young calves, total bile acid concentration may be more useful in establishing a diagnosis than blood ammonia concentration.

Congenital intrahepatic portosystemic venous shunt: An unusual feature in LEOPARD syndrome and in neurofibromatosis type 1

Congenital intrahepatic portosystemic venous shunt: An unusual feature in LEOPARD syndrome and in neurofibromatosis type 1

Hepatic Encephalopathy Due to Intrahepatic Portosystemic Venous Shunt Successfully Treated by Interventional Radiology

We treated a 66-year-old woman with hepatic encephalopathy secondarily induced by an intrahepatic portosystemic venous shunt (IPSVS). In serial observations, the volume of the liver became smaller and encephalopathy could not be controlled with conservative therapy. We occluded the IPSVS successfully using percutaneous transcatheter embolization with micro coils. Following embolization, encephalopathy disappeared and blood flow of all branches of portal vein improved. In cases with an IPSVS without liver cirrhosis, blood flow in the portal vein and liver volume must be followed carefully, and interventional radiology may be considered effective in those who do not show a satisfactory response to conservative therapy.

Congenital Intrahepatic Portosystemic Venous Shunt in an Infant with Down Syndrome

Congenital Intrahepatic Portosystemic Venous Shunt in an Infant with Down Syndrome

Intrahepatic portosystemic venous shunt passing through the left inferior phrenic vein and draining into the left renal vein

We report a case of an intrahepatic portosystemic venous shunt (IPSVS) passing through the left inferior phrenic vein and draining into the left renal vein and then to the inferior vena cava. We incidentally detected the IPSVS while performing a transcatheter arterial embolisation for the treatment of hepatocellular carcinoma. IPSVS with the left inferior phrenic vein as the draining vein is very rare. The complete pathway of this IPSVS could be clearly demonstrated by multidetector row CT during arterial portography.

P0384 THREE CASES OF CONGENITAL INTRAHEPATIC PORTOSYSTEMIC VENOUS SHUNT IN NEONATES.

Introduction: Congenital intrahepatic portosystemic venous shunt (CIHPSS) are very unusual abnormalities. Only 50 publications have been counted. They are defined as macroscopic communications between the portal and the systemic venous circulation. They are entirely or partially located within a heathy liver that functions without portal blood. When discovered early in life, they are in favour of a malformative origin of the shunt. HEREIN, we report three neonate observations with their icon-çography. For the case n°1, it was a color Doppler and ultrasound scanning for a fever checkup,, which diagnosed the CIHPSS. between the right portal vein and the right-sus hepatic vein. In the two other one, it was the antenatal color Doppler and ultrasound scanning which diagnosed shunts during the third term of pregnancy. Those three shunts were considered as type II, according to the PARK’s classification system for IHPSS anormalies, because they link up a portal branch to an hepatic vein in a same parenchymal segment. Methods: Case n°1 is now 6 years old and is still asymptomatic. A clinical, biological and ultrasonographic examination, once a year is sufficient. The vascular fistula resolved spontaneously when case n°2 was 28 months old and when case n°3 was 8,5 months old. Results: DISCUSSION: Normally, toxic metabolites of nutrients and residual activity of pancreatic enzymes are degraded by the liver. Here, due to the shunt, they bypass directly into the systemic circulation. Then, hyperammoniemia, trimethylaminuria, hyperinsulinemia, pulmonary hypertension or congestive heart failure can appear. THERAPY: Because of the rarity of this disorder, the choice of treatment is controversial. It depends on the natural course of the disease, but the majority of patients did not have symptoms until their 6th decade. Initially, the spontaneous resolution is expected. If hepatic encephalopathy or heart failure progress, some treatment may indicate: angiographic intervention with percutaneous coil embolisation, surgical intervention such as shunt ligation and hepatic resection or realisation of an alternative portosystemic shunt. Conclusion: CIHPSS have been thought to be uncommon, but improvement of imaging (US, CT, MRI) have shown even asymptomatic intrahepatic shunts in an increasing number of patients. Spontaneous resolution is frequent. Metabolic and hemodynamic repercussions will guide the management in other cases.

Fístula aneurismática portohepática venosa espontánea: diagnóstico por imagen

Intrahepatic portosystemic venous shunts not related to trauma or biopsy are infrequent and their etiology is controversial. A congenital or acquired origin due to cirrhosis and portal hypertension has been proposed. Hepatic encephalopathy is present when there is associated cirrhosis. We describe a case of aneurysmal portohepatic venous fistula that was incidentally diagnosed with conventional ultrasonography and was subsequently confirmed by Doppler ultrasonography and computed tomography scan. Because there were no symptoms of encephalopathy, no surgical or vascular percutaneous treatment was provided.

Symptomatic intrahepatic portosystemic venous shunt: embolization with an alternative approach.

Intrahepatic portosystemic venous shunt is relatively rare and not well recognized. Awareness of intrahepatic communications is important because they can cause encephalopathy, and most of these shunts can be completely cured by transcatheter embolization. In this study, we describe the angiographic findings and transcatheter embolization techniques using several approaches for the treatment of intrahepatic portosystemic venous shunt. Between 1989 and 2001, we treated 10 patients with symptomatic intrahepatic portosystemic venous shunt by performing transcatheter embolization with Gianturco coils, fibered platinum coils, detachable balloons, and detachable microcoils using one of three approaches to access the portal venous system: transileocolic obliteration (n = 2), percutaneous transhepatic obliteration (n = 4), or retrograde transcaval obliteration (n = 4). In all patients, complete obliteration or nearly complete obliteration was confirmed angiographically, and symptoms related to portal-systemic encephalopathy improved after treatment. Complications were observed in three patients: adhesive ileus in a patient treated by transileocolic obliteration and thrombosis of intrahepatic portal branches in two patients treated by percutaneous transhepatic obliteration. On angiography, two types of intrahepatic portosystemic venous shunt were seen: intrahepatic portal venous-hepatic venous communication and intrahepatic portal venous-perihepatic venous communication. Transcatheter embolization is effective for treatment of intrahepatic portosystemic venous shunt. Retrograde transcaval obliteration is the least invasive technique and is recommended as the first choice for treatment of portosystemic venous shunt except in patients with multiple shunts.

Spontaneous intrahepatic portosystemic venous shunt in leptospirosis: is it a rare association or coincidence?

Spontaneous intrahepatic portosystemic venous shunt in leptospirosis: is it a rare association or coincidence?

2 P US diagnosis of congenital intrahepatic portosystemic venous shunt (IPVS): A case report

2 P US diagnosis of congenital intrahepatic portosystemic venous shunt (IPVS): A case report

Diagnosis and follow‐up of congenital intrahepatic portosystemic venous shunt by ultrasounds

Intrahepatic portosystemic venous shunt (IPSVS) is mostly observed in adults in association with portal hypertension or cirrhosis and diagnosed by angiography. The congenital form of IPSVS occurs less frequently, without primary liver disease, and can lead to hepatic encephalopathy(HE). Usually, small portosystemic shunts, less than 2 mms. in size, are present in patients with cirrhosis, while the largest ones have a congenital origin. The etiology of the congenital form is controversial, but it is likely due to an incomplete fetal development of vitellin veins that give rise to portal venous system. Literature reports that in infants the disease is usually discovered casually either through routine metabolic screening for galactosaemia (1) or through follow up of a cystic liver detected by prenatal sonogram (2). With improvements in diagnostic imaging techniques, an increasing number of infants and children with asymptomatic IPSVS has been diagnosed. To date, the natural course and indications regarding surgical closure of the shunt have still not been well established (3). Now we are reporting a case of a 5-month-old infant admitted to our department for poor weight gain and diarrhoea. Physical examination and laboratory data including liver function tests were normal. Only lactose tolerance test showed lactose maldigestion. Abdomen ultrasonography showed an anechoic lesion in the anterior segment of the right lobe of the liver that was supplied by a branch of the right portal vein and drained by an enlarged branch of the right hepatic vein, without evident

Diagnosis and follow-up of congenital intrahepatic portosystemic venous shunt by ultrasounds

Acta PaediatricaVolume 90, Issue 10 p. 1209-1210 Diagnosis and follow-up of congenital intrahepatic portosystemic venous shunt by ultrasounds VA Caiulo, VA Caiulo Division of Paediatrics, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Brindisi.Search for more papers by this authorG Presta, G Presta Division of Paediatrics, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Brindisi.Search for more papers by this authorG Latini, Corresponding Author G Latini Division of Paediatrics, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Brindisi. Giuseppe Latini, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Division of Paediatrics, Piazza A. Di Summa, IT-72100 Italy Brindisi, (e-mail, gilatini@tin.it)Search for more papers by this authorG Mattiolr, G Mattiolr Division of Paediatrics, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Brindisi.Search for more papers by this authorV Jasonni, V Jasonni Division of Paediatric Surgery, Istituto G. Gaslini, Genoa, Italy.Search for more papers by this author VA Caiulo, VA Caiulo Division of Paediatrics, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Brindisi.Search for more papers by this authorG Presta, G Presta Division of Paediatrics, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Brindisi.Search for more papers by this authorG Latini, Corresponding Author G Latini Division of Paediatrics, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Brindisi. Giuseppe Latini, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Division of Paediatrics, Piazza A. Di Summa, IT-72100 Italy Brindisi, (e-mail, gilatini@tin.it)Search for more papers by this authorG Mattiolr, G Mattiolr Division of Paediatrics, Azienda Ospedaliera A. Di Summa, Ospedale A. Perrino, Brindisi.Search for more papers by this authorV Jasonni, V Jasonni Division of Paediatric Surgery, Istituto G. Gaslini, Genoa, Italy.Search for more papers by this author First published: 02 January 2007 https://doi.org/10.1111/j.1651-2227.2001.tb03259.xCitations: 11AboutPDF 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 onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume90, Issue10October 2001Pages 1209-1210 RelatedInformation

Intrahepatic portosystemic venous shunts: spectrum of CT findings in external and internal subtypes.

The purpose of this work was to survey the spectrum of CT findings in intrahepatic portosystemic venous shunts (IPSVSs). One thousand consecutive liver CT scans examined with an enhanced helical technique were retrospectively reviewed on workstation to find IPSVSs. IPSVSs were noted in 37 patients and divided into two subtypes according to the location of the communicating systemic vein, either outside (external type, n = 34) or within (n = 4) the liver (one patient had both internal and external types). All the external-type shunts were noted in cases with portal hypertension (n = 34). Most shunts (n = 30) ran through segment 4 and/or 3 and came out near the falciform ligament, but five shunts were noted in segment 2 communicating either with the systemic vein (n = 3) or probably with an enlarged left gastric vein (n = 2). Solitary portohepatic venous shunts (internal type) were noted in three cases with (n = 2) or without (n = 1) aneurysmal dilatation and many portohepatic venous shunts in another patient. IPSVSs of the external type were far common than those of the internal type, always associated with increased pressure of the portal system and in specific sites probably lacking the hepatic capsule.

Increased hepatic arterial blood flow after decreased portal supply to the liver parenchyma owing to intrahepatic portosystemic venous shunt: angiographic demonstration using helical CT.

This study was conducted to investigate the haemodynamics of the liver parenchyma in the presence of intrahepatic portosystemic venous shunt. 3 patients with intrahepatic portosystemic venous shunts and 24 patients with normal intrahepatic haemodynamics underwent both CT arterial portography and CT during hepatic arteriography. Angiographic findings with helical CT were compared, and CT attenuated values were measured in both groups. The liver parenchyma on CT arterial portography had lower attenuation than on CT during hepatic arteriography in all patients with intrahepatic portosystemic venous shunts. Overall average CT attenuation was 92.2 +/- 7.7 Hounsfield units (HU) on CT arterial portography and 149.9 +/- 8.5 HU after CT during hepatic arteriography, with the opposite findings in all patients without intrahepatic portosystemic venous shunt: CT attenuation 142.0 +/- 25.7 HU on CT arterial portography and 100.7 +/- 16.4 HU after CT during hepatic arteriography. In conclusion, the portal venous supply to the liver parenchyma decreased due to intrahepatic portosystemic venous shunts, with a compensatory increase in hepatic arterial blood supply.

Intrahepatic spontaneous portosystemic venous shunt: Value of color and power Doppler sonography

Intrahepatic spontaneous portosystemic venous shunt: Value of color and power Doppler sonography

A rare intrahepatic portacaval tubular shunt in a patient with spastic paraparesis

Although there are numerous communications between the portal and systemic venous systems, intrahepatic portosystemic venous shunts are not frequently encountered in clinical practice. Here we report a patient who presented with spastic paraparesis, who was found to have chronic liver disease with tubular intrahepatic portacaval shunting.

Imaging of congenital abnormalities of the portal venous system.

Although congenital abnormalities of the portal venous system are uncommon, they are sometimes encountered incidentally because of the widespread use of cross-sectional imaging techniques. These abnormalities include the preduodenal portal vein. duplication of the portal vein, portal vein aneurysm, rotation of the superior mesenteric vein. variations in portal venous tributaries, intrahepatic portosystemic venous shunts, and mesenteric vascular malformations. This pictorial essay illustrates the normal anatomy and the congenital abnormalities of the portal venous system as shown by radiologic imaging. focusing on the value of CT and MR imaging in diagnosing these abnormalities. Familiarity with the varied features of congenital abnormalities of the portal venous system will permit more accurate diagnoses and will help prevent false pathologic diagnoses.

Three brothers with progressive hepatic dysfunction and severe hepatic steatosis due to a patent ductus venosus

Three Japanese brothers with progressive deterioration of hepatic function and fatty degeneration of the liver eventually leading to hepatic encephalopathy were recently encountered. Each of them had a congenital intrahepatic portosystemic venous shunt due to a patent ductus venosus. Liver dysfunction and hepatic steatosis reverted to normal with surgical correction of the ductus venosus. Our observations suggest that impairment of liver function occurs first in the presence of malnutrition related to a reduction of blood in the portal vein. Hepatic steatosis is a consequence of a depleted metabolism of hepatocytes. Congenital portosystemic venous shunt due to a patent ductus venosus in this family has a genetic background. (Gastroenterology 1996 Jun;110(6):1964-8)