case_images: PMC10871735_01
case_images: Clinical course of the patient. Serial changes in the PVA diameter, platelet count, ALBI score, and medications are shown. EVL, endoscopic variceal ligation; EIS, endoscopic injection sclerotherapy; AT III, antithrombin III; RFA, radiofrequency ablation; DAA, direct-acting antiviral; PVA, portal vein aneurysm; ALBI, albumin-bilirubin.
case_images: crg-2024-0018-0001-535957_F01.jpg
case_images: PMC10871735_01_crg-2024-0018-0001-535957_F01.jpg
case_images: F1
case_images: The clinical course of the patient is shown in Figure 1.
case_images: Images at initial diagnosis of the PVA in 2004 (a-c) and thrombus in the PVA in 2010 (d, e). Axial (a) and coronal (b) plane images of contrast-enhanced CT show an enhancing ovoid lesion at the confluence of the splenic vein and superior mesenteric vein (arrows). The abdominal ultrasound image shows an anechoic dilatation of the portal vein through the short (left) and long (right) axes on subcostal view (c). Axial (d) and coronal (e) plane images of the contrast-enhanced CT show the enlarged PVA with internal thrombus (arrows).
case_images: crg-2024-0018-0001-535957_F02.jpg
case_images: PMC10871735_01_crg-2024-0018-0001-535957_F02.jpg
case_images: F2
case_images: The CT image did not reveal any tumor in the liver; however, there was an ovoid, homogenous, highly enhancing lesion with a diameter of 28 mm at the confluence of the splenic vein and superior mesenteric vein (Fig. 2a, b). At that time, abdominal US showed limited dilatation of the portal vein due to the PVA (Fig. 2c). In 2010, contrast-enhanced CT showed the PVA with a diameter of 38 mm and an internal thrombus (Fig. 2d, e).
case_images: Images in 2021. Axial (a) and coronal (b) plane images of contrast-enhanced CT show the diameter of the PVA is 52 mm with no thrombus (arrows). An abdominal ultrasound image shows an anechoic lesion (c) with color flow (d) and flat venous flow (e).
case_images: crg-2024-0018-0001-535957_F03.jpg
case_images: PMC10871735_01_crg-2024-0018-0001-535957_F03.jpg
case_images: F3
case_images: The diameter of the PVA remained at 52 mm (Fig. 3a, b). US showed an anechoic lesion with no recurrence of thrombus (Fig. 3c). Using the color Doppler method, the blood flow in the aneurysm was seen as bidirectional due to the swirling of blood, which is the so-called yin-yang sign (Fig. 3d), while a flat venous flow was observed inside the aneurysm using the pulsed-wave Doppler method (Fig. 3e).