Abernethy malformation type 1b - acute spontaneous hepatic hemorrhage
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Abrupt onset shock and neck pain, systolic blood pressure 75 mmHg
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Large acute subcapsular hepatic hematoma compressing the liver parenchyma. Moderate hemoperitoneum.
Anomalous portal vein draining into the confluence of the IVC and hepatic veins, bypassing the liver.
Large hepatic artery and veins. Enlarged peripheral hepatic veins. Heterogeneous liver enhancement. Elongated right lobe.
This patient was diagnosed with ASD, VSD and cor triatriatum in childhood and these required surgical correction. Her congenital extrahepatic portosystemic shunt was not recognized until this acute presentation as she has no features of hepatic encephalopathy. Her portal vein connects to the IVC bypassing the liver; the liver is exclusively supplied by the hepatic artery.
Hepatic angiogram demonstrated large hepatic arteries, but no active hemorrhage or vascular malformations. There were no hepatic tumors. Hemorrhage was presumably related to the enlarged blood vessels. The subcapsular hematoma resolved following percutaneous drainage and laparoscopic washout by the liver surgeon.
NB. Practical point: include vasculature in your systematic review. Vascular anomalies and diseases are frequently overlooked!
- 1. Azad S, Arya A, Sitaraman R, Garg A. Abernethy Malformation: Our Experience from a Tertiary Cardiac Care Center and Review of Literature. Ann Pediatr Card. 2019;12(3):240. doi:10.4103/apc.apc_185_18 - Pubmed
- 2. Sharma S, Bobhate P, Sable S et al. Abernethy Malformation: Single-Center Experience from India with Review of Literature. Indian J Gastroenterol. 2018;37(4):359-64. doi:10.1007/s12664-018-0884-3 - Pubmed