Presentation
Initially presenting with right upper quadrant pain. Gallstones were identified on ultrasound, in addition to a dilated vascular lesion at the level of the porta hepatis.
Patient Data
A large extrahepatic portal venous aneurysm is evident at the splenomesenteric venous confluence, measuring around 4.8 x 4.8 cm in maximal cross-sectional dimensions.
The intrahepatic portal vein is normal in caliber. No portal venous thrombosis.
No signs of portal hypertension.
Calcified gallstone.
Coronal and sagittal maximum intensity projections depicting the extrahepatic portal vein aneurysm.
Case Discussion
Aneurysmal dilatation of the portal vein is in itself a very rare occurrence. However, when present, it most likely involves the splenomesenteric venous confluence, as in this case.
Congenital and acquired theories have been proposed. In the acquired types, chronic liver disease and portal hypertension are thought of as the main culprits. The congenital types are usually discovered incidentally, as no underlying liver disease is present, and are increasingly being detected due to the increased availability of cross-sectional imaging.
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