A 74-year-old woman with cirrhosis due to Child's B8 hemochromatosis with multiple admissions was diagnosed with recurrent severe hepatic encephalopathy (17 admissions in 20 months).
Conventional abdominal ultrasound showed a heterogeneous liver parenchyma without space occupying lesions compatible with chronic liver disease, a permeable portal vein of 13 mm and a slightly enlarged homogeneous spleen (13 cm).
On the other hand, the doppler study of demonstrates the reversal of flow in the portal and splenic veins, without visualizing a clear portosystemic shunt.
Computed tomography angiography revealed a marked collateral circulation and an associated shunt.
The patient continued to present persistently high fever.
Median interventional radiology was performed partial embolization of the shunt with microcoils showing marked slowing of blood flow through the shunt.
Abdominal ultrasound after embolization showed a portal flow hepatopeto with persistent hepatofugal flow in the splenic vein and decreased perisplenic collateral circulation.
After embolization, the patient experienced immediate clinical improvement, with normalization of consolidation rates.
In the 18 months following embolization of the hepatic shunt, three patients required hospitalization for mild hydropic shunt, hepatorenal syndrome and grade I hepatic encephalopathy.
