Portal venous aneurysm

B mode ultrasonography often visualises an anechoic cyst like lesion in proximity to the porta hepatis, while, addition of a Doppler study substantiates the diagnosis of an aneurysm by revealing a non-pulsatile monophasic waveform within the lesion signifying the presence of blood flow. There are no...

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Bibliographic Details
Published in:BMJ case reports 2021-07, Vol.14 (7), p.e244704
Main Authors: Tan, Rebekah Li Wei, Ng, Zi Qin
Format: Article
Language:English
Subjects:
Abdomen
Aneurysm - diagnostic imaging
Aneurysms
Case reports
Cysts
Humans
Hypertension
Images In
Male
Pancreatitis
Portal Vein - diagnostic imaging
Surveillance
Thrombosis
Ultrasonic imaging
Veins & arteries
Young Adult
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Summary:B mode ultrasonography often visualises an anechoic cyst like lesion in proximity to the porta hepatis, while, addition of a Doppler study substantiates the diagnosis of an aneurysm by revealing a non-pulsatile monophasic waveform within the lesion signifying the presence of blood flow. There are no consensus guidelines for when surgical intervention is indicated, however, should be considered if symptomatic, expanding at a rapid rate, presents a high risk of thrombosis, rupture, compression on adjacent structures or if there is evidence of biliary tract obstruction and haemobilia.2 Portacaval or mesocaval shunting to reduce portal pressure and prevent progressive dilation of PVA have been described for those with portal hypertension.3 Thrombectomy has been recommended for patients with PVA associated with thrombosis extending to the superior mesenteric and splenic veins. In those without portal hypertension, aneurysmography and aneurysmectomy have been the preferred treatment for saccular and fusiform aneurysms respectively as it allows for the preservation of the portal circulation and reinstates laminar flow in the portal vein.4 In our case, given its relatively asymptomatic small size of PVA, we elected for surveillance with ultrasonography.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-244704