Portocaval shunt with unusual CT and MR manifestations.

OBJECTIVE

We investigated the radiological findings of three cases with unusual portocaval shunts.

MATERIALS AND METHODS

Three patients with liver cirrhosis and portal hypertension were examined using CT and MRI. CT was performed using intravenous bolus injection of contrast medium in one and with incremental dynamic scanning in two cases. MRI was performed with a 1.5 or 0.5 T superconducting system or with a 0.22 T resistive system in the three patients.

RESULTS

CT and MRI showed tortuous intrahepatic tubular structures connecting the right posterior portal vein to the inferior vena cava (IVC) in two of the patients. An anomalous vein arising from the extrahepatic portal vein was a tributary connected with the IVC in one patient. Symptoms associated with hepatic encephalopathy were present in two of the patients whose blood ammonia levels were elevated.

CONCLUSION

The possibility of the existence of hepatic encephalopathy should be borne in mind when these shunts are detected during abdominal imaging.