Congenital portosystemic shunt
Abdominal pain and nausea. Elevated liver function tests.
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Visualisation of a hypo-echoic multinodular lesion in segment 5 of the liver (Couinaud classification).
Doppler imaging shows multidirectional flow in the lesion.
A multinodular hypoechoic lesion, intrahepatic, with multidirectional flow on Doppler imaging is strongly suggestive of a vascular malformation.
Dynamic ultrasound study shows a portal branch and hepatic vein branch running into this lesion, making this a portosystemic shunt. With an insignificant clinical history (in particular no TIPSS procedure) and no prior ultrasound studies, this portosystemic shunt is presumed to be congenital.