Transjugular intrahepatic portosystemic shunt (TIPS)

Case contributed by Dr Mostafa El-Feky

Presentation

History of Budd-Chiari syndrome managed with TIPS shunt since 2 years, presented for follow up.

Patient Data

Age: 40 years
Gender: Female

Transjugular intrahepatic portosystemic shunt (TIPS) is noted connecting the inferior vena cava (IVC) to the portal vein with no evidence of narrowing. It shows patent lumen with a good steady venous flow with a velocity averaging 60 cm/sec. Patent portal vein and IVC.

The liver shows mild cirrhotic changes, seen as coarse echotexture and mild border irregularity. The spleen shows average size measuring 10.6 cm in bipolar diameter.

Follow up after 6 months (second stack) revealed preserved patency and phasic waveform.

Case Discussion

Normal TIPS shows good color Doppler saturation throughout its length with no focal aliasing, with velocities higher than the portal vein. Shunt stenosis is usually associated with signs of portal hypertension as splenomegaly and ascites.

False-positive result of shunt dysfunction may result from suboptimal Doppler settings, that is partially unavoided in this case as:

  • aliasing in the shunt as the PRF is low
  • mild decreased flow velocity; as the Doppler steer is not ideally angled on the shunt flow (suboptimal angle of acquisition)

Repeated Doppler acquisition along the different parts of the shunt was done to rule out stenosis or focal velocity change along the shunt.

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