Cirrhosis with portal hypertension and dilation of paraumbilical veins
Presentation
Presents to the emergency department with jaundice and left lower quadrant abdominal pain. Denies fever, chills, nausea, vomiting, diarrhea, constipation, or abdominal bloating. Known history of alcoholic cirrhosis and chronic anemia.
Patient Data
Ultrasound reveals cirrhotic liver morphology, portal vein turbulent and hepatofugal flow, and dilated paraumbilical veins. The findings might suggest portal hypertension. Also, an abdominal ultrasound shows gallbladder wall thickening and a small amount of pericholecystic fluid, which might relate to underlying liver disease and dilated CBD without choledocholithiasis.
CT shows cirrhosis with portal hypertension and splenomegaly, upper abdominal varices, mild ascites, and dilated paraumbilical veins. Images suggest mild gallbladder wall thickening and cholelithiasis.
Case Discussion
The clinical presentation and abnormal laboratory findings (elevated bilirubin, alkaline phosphatase, GGT, AST, ALT, and decreased albumin) suggest a worsening liver function in this patient with a history of alcoholic cirrhosis.
Ultrasound and CT findings indicate dilation of paraumbilical veins secondary to portal hypertension in this patient with cirrhosis.
Paraumbilical veins are anastomosis between the ventral abdominal wall and the left portal vein. Patent and dilated paraumbilical veins might be present in cases of portal hypertension, as they help to compensate for hypertension.
Acknowledgments: I would like to recognize Tochukwu Duru, MD, and Jing Harakh, MD, Diagnostic Radiology Department, for assisting in the creation of this case.
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