Enlarged extrahepatic portal vein aneurysm in a non-cirrhotic patient: a therapeutic dilemma

The Reply

“…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. 4 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.…”

Extra-hepatic portal vein aneurysm diagnosed by EUS

“…[ 1 2 ] PVA is usually diagnosed by abdominal Doppler ultrasonography, and computed tomography/magnetic resonance imaging can help in confirming the diagnosis in case of ambiguous sonography findings. [ 3 ] EUS has been rarely used to diagnose PVA, and its detailed findings have not been described in the literature. [ 4 ] The natural history of PVA is unclear, and therefore, there is no consensus of its management.…”

“…Currently, asymptomatic PVA is managed conservatively with serial monitoring, and interventional surgical or endovascular treatment is offered to patients with complicated PVA. [ 1 2 3 ]…”

Role of Cholelithiasis in Development of Portal Vein Aneurysm

“…A study by Koc et al 4 reported choledocholithiasis as an additional finding in 1 patient with 4 portal vein aneurysms. Fujikawa et al 5 reported a 75-year-old woman having asymptomatic gallstone and portal vein aneurysm adjacent to the gallbladder.…”