Portohepatic Venous Shunt

Although intrahepatic portal systemic (hepatic) venous shunt had been thought to be a rare disease, recent advances in ultrasound, CT, and MRI have made it possible to depict this condition in an increasing number of patients (Figs. A). A high degree of shunt may produce hepatic encephalopathy due to hyperammonemia. Single or multiple shunts may be present, and there may be other anomalies such as membranous obstruction of the IVC. It has recently been reported that hepatic adenoma, hepatocellular carcinoma, or nodular hyperplasia may develop in the ischemic liver in the presence of portosystemic shunts.

FIG A

Radiology Imaging “Portohepatic venous shunt”
Longitudinal color Doppler sonogram (depicted in gray
scale) of the liver shows the portal (straight arrow) and
hepatic (curved arrow) venous limbs of a congenital
portohepatic venous shunt

“Radiology imaging” Intrahepatic portal–hepatic venous shunt

A 32-year–old woman was admitted because of altered mental status with vague physical symptoms for a few years.
(a and b) A large shunt (arrows) between the posterior branch of the right portal vein (P) and an enlarged right hepatic vein (RH) was discovered and confirmed by ultrasound (color Doppler ultrasonography, transverse scans, depicted in gray scale).
(c) Angiography with the catheter tip placed in the portal vein demonstrates a large shunt (arrows) between the right portal
vein and enlarged right hepatic vein.

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