case_images: PMC4813081_01
case_images: An 8-year-old female child with multiple focal nodular hyperplasia-like lesions. Axial CT image in portal venous phase (A) shows multiple minimally enhancing lesions in both lobes of liver (long white arrow) (B) Abnormal portal venous channel connecting the right portal vein and IVC (curved arrow), consistent with portocaval shunt (C) Heterogeneous lesion at segment VI (black arrow) and hypertrophied hepatic artery (short white arrow)
case_images: IJRI-26-92-g001.jpg
case_images: PMC4813081_01_IJRI-26-92-g001.jpg
case_images: F1
case_images: Arterial phase showed mild and homogenous enhancement of all focal lesions except one lesion which showed a heterogeneous enhancing pattern [Figure 1A and B]. The hepatic artery was hypertrophied and tortuous [Figure 1C]. Right intrahepatic portal vein was seen to drain directly into the hepatic segment of inferior venacava (IVC) [Figure 1B].
case_images: PMC4813081_02
case_images: A 36-year-old female presented with encephalopathy. Axial CT image in portal phase (A) shows the anterior branch of the right portal vein joining with the right hepatic vein (black arrow). Portogram (B) showing venous sac connecting the portal vein (white arrow) with the right hepatic vein (black arrow) (C) Introduction of the Amplatz vascular device (arrow) through 6F vascular sheath (D) Deployment of metallic coils (arrow) proximal to the Amplatz occluder device. Post embolization angiogram (E) showing occlusion of the portosystemic venous shunt
case_images: IJRI-26-92-g002.jpg
case_images: PMC4813081_02_IJRI-26-92-g002.jpg
case_images: F2
case_images: The larger shunt involved drainage of the entire anterior branch of the right portal vein into the right hepatic vein [Figure 2A]. Portogram showed a large venous sac connecting the right anterior division of portal vein with right hepatic vein [Figure 2B]. Amplatz closer device was deployed to prevent distal migration of coils, following which 8 x 8 mm and 6 x 6 mm (0.35'') stainless steel coils (Cook, Bloomington, IN) were placed to embolize the shunt [Figure 2C-E].