case_images: PMC6159295_01
case_images: Coronal reformatted contrast-enhanced CT image (a) demonstrates right hepatic lobe lesions. The white arrow focuses on the extra vessel arising from the portal vein. Axial CT image at the level of the main portal vein (b) shows a right hepatic lobe mass with diminutive portal vein (white arrow). Axial image (c) redemonstrates an extra vessel (white arrow) arising from the main portal vein. Axial CT image at a more inferior level (d) shows a dilated tortuous vessel descending along the left para-aortic space (white arrow) with inferior vena cava anastomosis at the level of the aortic bifurcation (black arrow).
case_images: bjrcr.20150077.g001.jpg
case_images: PMC6159295_01_bjrcr.20150077.g001.jpg
case_images: f1
case_images: Further evaluation with contrast-enhanced CT scan showed a mildly nodular hepatic surface contour with two heterogeneously enhancing or hyperdense masses containing central areas of diminished attenuation within segments 6 and 7 of the right hepatic lobe (Figure 1). A large tortuous complex shunt was noted (maximum transverse diameter of 2.0 cm) to arise from the portal vein bifurcation with connections to the left renal vein and descending along the aorta to communicate with the inferior vena cava at the level of the L2-3 vertebrae (Figures 1 and 2).
case_images: Anterior (a) and posterior (b) three-dimensional reconstruction images demonstrate a dilated vessel arising from the portal vein with a descending tortuous portion along the left para-aortic space. Connection to the inferior vena cava is better appreciated on the posterior projection (white circle).
case_images: bjrcr.20150077.g002.jpg
case_images: PMC6159295_01_bjrcr.20150077.g002.jpg
case_images: f2
case_images: A large tortuous complex shunt was noted (maximum transverse diameter of 2.0 cm) to arise from the portal vein bifurcation with connections to the left renal vein and descending along the aorta to communicate with the inferior vena cava at the level of the L2-3 vertebrae (Figures 1 and 2).
case_images: Axial images from contrast-enhanced CT scan performed in September 2004 (a-d). There is a normal calibre portal vein (white arrows, a) as well as an extra vessel arising from the portal vein (white arrows, b). Images (c) and (d) demonstrate tortuous shunt along the left para-aortic space (white circles); the shunt, however, is smaller in calibre compared to its size from 2014.
case_images: bjrcr.20150077.g003.jpg
case_images: PMC6159295_01_bjrcr.20150077.g003.jpg
case_images: f3
case_images: The described portosystemic shunt was present; however, it was significantly smaller in calibre compared to the current examination, measuring 9 mm in the transverse diameter (Figure 3).