Transjugular intrahepatic portosystemic shunt stenosis

Case contributed by Dr Sami Elhinnawi

Presentation

Hepatic cirrhosis with TIPS insertion 2 weeks ago. Abdominal distension and dyspnea.

Patient Data

Age: 50 years
Gender: Male

There is evidence of aliasing at the IVC side of the TIPS.

The velocity at the portal side measures 73 cm/sec and at the distal (hepatic vein) portion of the TIPS where the aliasing is seen, the velocity measures around 280 cm/sec which is diagnostic of stenosis.

The main portal vein is patent showing hepatopetal flow, however the portal vein branches are thrombosed.

Marked volume of ascites could be seen.

Case Discussion

Normal TIPS velocity ranges from 90-190 cm/sec. Velocity >190 cm/sec is diagnostic of stenosis, with a drop in flow distal to a stenosis.

Here in this case the velocity exceeds 280 cm/sec. Colour aliasing at this site also aids diagnosis.

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Case information

rID: 55630
Case created: 18th Sep 2017
Last edited: 22nd Sep 2017
Inclusion in quiz mode: Included
Institution: Misr International Hospital

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