CASE 1952 Published on 06.02.2003

Aneurysmal intrahepatic portal-hepatic venous shunt

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

E. Vasiliadi, X. Dimopoulos, P. Siemou, A. Tzannetaki, G. Pampouras

Patient

85 years, male

Categories

No Area of Interest ; Imaging Technique Ultrasound, Ultrasound-Power Doppler, Ultrasound-Colour Doppler, Ultrasound-Colour Doppler, CT, MR, MR, MR

No Procedure ; No Special Focus ;

Show more Show less

Download as PDF Print Show related cases Notify admin

Clinical History

Ultrasound in an asymptomatic patient showed an anechoic lesion of 25mm in the right lobe of the liver, that was communicating with the right hepatic vein and the right portal vein.

Imaging Findings

The patient was referred for diagnosis and treatment of a bladder neoplasm. There was no evidence of liver disease or encephalopathy nor a history of trauma, liver biopsy, abdominal surgery or alcohol abuse. Blood tests showed normal liver function and glucose levels.

Ultrasound showed an anechoic lesion of 25mm without distal enhancement in the right lobe of the liver, segment VI, that was communicating with the right hepatic vein (RHV) and the right portal vein (RPV).

Colour doppler sonography confirmed the vascular nature of the lesion. Flow direction indicated that the aneurysm was supplied by the RPV and drained by the RHV. Flow within the aneurysm was rotative. The flow velocity of the portal vein was 97cm/s. The hepatic artery was wider than normal (6.3mm) and its flow velocity was 189cm/s. No signs indicative of portal hypertension or other portal-systemic communication were noted.

Non-contrast CT demonstrated a low-density lesion, while contrast-enhanced CT scans showed enhancement similar to vessels. The anatomical continuity to the RHV and RPV was proven. MR tests (spin echo, FSE with fat suppression, gradient echo, dynamic contrast-enhanced techniques) clearly depicted the lesion and confirmed its vascular nature. Fast contrast washout was noticed 3 minutes after the i.v. injection of contrast medium.

Discussion

Intrahepatic portal-hepatic venous shunts (IH-PHVS) of aneurysmal type (type III) are rare entities and fewer than 25 cases have been published. Most of these cases were described in cirrhotic patients with portal-systemic encephalopathy. The case reported here is an asymptomatic aneurysmal IH-PHVS that was demonstrated by B-mode ultrasound and confirmed by colour doppler US, CT and MR imaging.

As the shunt was asymptomatic and the liver function tests were normal, no further investigation or intervention was recommended and the finding was considered as a congenital malformation.

Differential Diagnosis List

Aneurysmal intrahepatic portal-hepatic venous shunt

Final Diagnosis

Aneurysmal intrahepatic portal-hepatic venous shunt

References

[1] Chagnon SF, Vallee CA, Barge J, Chevalier LJ, Le Gal J, Blery MV. Aneurysmal portahepatic venous fistula: report of two cases. Radiology 1986 Jun;159(3):693-5. (PMID: 3517953)

[2] Takayasu K, Moriyama N, Shima Y, Muramatsu Y, Goto H, Yamada T, Makuuchi M, Yamasaki S, Okazaki N. Spontaneous portal-hepatic venous shunt via an intrahepatic portal vein aneurysm. Gastroenterology 1984 May;86(5 Pt 1):945-8. (PMID: 6706076)

[3] Gheorghiu D, Leibowits O, Bloom RA. Case report: asymptomatic aneurysmal intrahepatic porto-hepatic venous shunt -- diagnosis by ultrasound.
Clin Radiol. 1994 Jan;49(1):64-5. (PMID: 8299337)

[4] Tanaka S, Kitamura T, Fujita M, Iishi H, Kasugai H, Nakanishi K, Okuda S.
Center for Adult Diseases, Osaka, Japan. Intrahepatic venous and portal venous aneurysms examined by color Doppler flow imaging. J Clin Ultrasound 1992 Feb;20(2):89-98. (PMID: 1314270)

Case information