Cavernous vessels around a patent portal trunk in the liver hilum.

OBJECTIVES

Cavernous transformation of the portal vein (CTPV) is considered a sequel to extrahepatic portal vein obstruction. However, we have observed an unusual finding of cavernous vessels around a patent portal trunk in the liver hilum. The aim of our study is to describe the imaging features, clinical profiles, management, and outcome of these patients.

MATERIAL AND METHODS

We re-evaluated the images of all consecutive non-malignant and non-cirrhotic patients with a diagnosis of CTPV admitted to our department between July 2002 and June 2010. The patients with a patent portal trunk were enrolled in this study.

RESULTS

A total of five patients had cavernous vessels around a patent portal trunk. Of them, all presented with abdominal distension, and one with recurrent variceal bleeding. Hepatomegaly and splenomegaly were found in one and four patients, respectively. All but one with previous splenectomy had a decreased platelet count. Three patients had a high level of alkaline phosphatase and/or γ-glutamyl transferase. Serum bilirubin, albumin, and creatinine were in normal range. Endoscopy demonstrated varices in three patients. Mild ascites was detected in one patient by ultrasound. Conservative therapy was given to two patients with mild abdominal discomfort. Splenectomy or partial spleen embolization was given to two patients with hypersplenism. A transjugular intrahepatic portosystemic shunt insertion was performed in one patient for the prevention of recurrent variceal bleeding. All patients were alive during follow-up.

CONCLUSIONS

These unusual findings led us to believe that cavernous vessels could develop around a patent portal trunk. Further studies are necessary to explore its pathogenesis.