Incidental intra-hepatic portal vein-hepatic vein fistula

Case contributed by Dr Chris O'Donnell

Presentation

Incidental finding on CT abdomen for suspected renal obstruction

Patient Data

Age: 90
Gender: Female

Abnormal collection of vessels in the left heptic lobe, fed from the left portal vein and draining via the middle hepatic vein into the IVC.  Note dilalation of the biliary tree possibly related to previoulsy cholecystectomy.  The hepatic enhancement pattern is also a little patchy.  I wonder if this is a perfusion phenomenon due to diversion of portal venous blood through the fistula.

Case Discussion

These shunts are rare, usually in the left hepatic lobe and often of dubious significance.  The coonection is often aneurysmal (not in this case).  The patients often do not have cirrhosis nor have they had medical interventional.  They rarely require treatment but can be associated with hepatic encephalopthy due to bypass of liver metabolism by portal venous blood.

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Case Information

rID: 43557
Case created: 16th Mar 2016
Last edited: 30th Mar 2016
Inclusion in quiz mode: Included

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