Portal venous varix

Case contributed by Doaa Faris Jabaz

Presentation

Abdominal pain.

Patient Data

Age: 30 years
Gender: Male
ct

  • mild fusiform dilatation of the SMV without loss of wall parallelism (luminal diameter of 16mm) mainly at its junction, with normal diameter splenic vein, the confluence measure 18mm, the main portal vein (MPV) is of accepted diameter (14-15) mm
  • at the porta hepatis, the MPV gives rise to a short normal diameter left portal vein (segments II/III veins) and aneurysmal right portal vein (diameter of 22-24mm), from its posterior aspect, normal diameter right segmental veins arise anteriorly, the distal right portal vein measures (20x23) mm related to the obliterated umbilical vein/ligament and gives rise to segment IV vein
  • no CT signs of portal hypertension, no thrombosis or rupture, no compression of the bile ducts, and no shunt. On targeted Doppler US (not shown), a helical flow is seen due to the segmental widening however the net flow is hepatopetal with a normal waveform
  • the gallbladder is located adjacent to the umbilical ligament and does not serve as a boundary between the right and left lobes
  • impression: intrahepatic right portal venous fusiform varix mostly congenital, no detectable complication, stable on reviewing his older US at 2017, further workup is not necessary

Case Discussion

Most patients with portal vein aneurysms don't have portal hypertension or chronic liver disease, especially in congenital cases which are usually detected incidentally while investigating a non-specific abdominal pain, like this case. Being non-complicated and of stable appearance on ultrasound over years, is reassuring and as such recommending further workup may not be justifiable.

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