Intrahepatic portal-systemic shunt: Its etiology and diagnosis

Abstract

Four cases of enormous shunt between portal and hepatic veins (portal-hepatic venous shunt) are reported with special reference to sonographic and portographic findings. Ultrasonography, an examination for screening, delineated a snail-like anechoic area in the liver, its connection with the portal and hepatic veins, and marked dilatation of the veins connecting with the shunt. Transarterial or percutaneous transhepatic portography, a method for definitive diagnosis, demonstrated large pooling of the contrast medium flowing from the dilated portal branch and subsequent visualization of the hepatic vein. The etiology and prognosis are unknown at present. The most likely pathogenesis for this shunt seemed to be a congenital anomaly, namely, persistence of the omphalomesenteric venous system. With recent advances in and the more frequent use of real-time ultrasonography, detection of this kind of vascular abnormality will doubtless increase.

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

“…Another case was reported of a newborn with a shunt with spontaneous resolve in first year of age (8,13). SIPSVS may be demonstrated in any age of life between 20-day-old and late seventies (3,5,12,14,18,19,20,22,24,26,31). Wide range distribution in case reports may make us speculate role of different mechanism in development of SIPSVS.…”

“…The late hyperinsulinism then leads to secondary hypoglycemia. These cases may benefit dietetic treatment (7,9,12,18).…”

Hypergalactosaemia and portosystemic encephalopathy due to persistence of ductus venosus Arantii

“…Intra-and extrahepatic venous anomalies mediating portosystemic shunting have been described in at least 24 patients [2,4,11,13,20,21,22,25,26,32] and in one dog [16]. In 11 of the patients, and in the dog, encephalopathy developed, in 5 of the patients decades before the venous anomaly was diagnosed [4,13,22,25].…”

Magnetic resonance imaging of macroscopic intrahepatic portal-hepatic venous shunts

“…Extrahepatic hepatofugal shunts are well-visualized radiol0gi-cally, whereas microscopic intrahepatic shunts are beyond the resolution of an imaging test. Macroscopic IPHVS were rarely detected before the widespread use of US and CT. Horiguchi et al [4] reported only two cases [10,11] before the introduction of these diagnostic modalities, while six cases, including those of their own, were reported within 2 years after their use. Likely etiologies of these macroscopic shunts include congenital [101, rupture of portal venous aneurysm [12,13], patent or reopening of ductus venosus [1] in a cirrhotic patient, and acquired vascular disorder as a sequela to parenchymaI collapse from hepatitis [11].…”

“…Summary of five patients with macroscopic IPHVS raphy (US) and computed tomography (CT), a rare entity of intrahepatic direct communication between a portal venous branch and the hepatic vein [macroscopic intrahepatic portal-hepatic venous shunt (IPHVS)] has been sporadically reported [1][2][3][4][5]. Magnetic resonance imaging (MRI) findings of this entity, however, have not been reported.…”