Congenital intrahepatic portosystemic venous shunt and liver mass in a child patient: successful endovascular treatment with an amplatzer vascular plug (AVP)

Abstract

A congenital intrahepatic portosystemic shunt is a rare anomaly; but, the number of diagnosed cases has increased with advanced imaging tools. Symptomatic portosystemic shunts, especially those that include hyperammonemia, should be treated; and various endovascular treatment methods other than surgery have been reported. Hepatic masses with either an intra- or extrahepatic shunt also have been reported, and the mass is another reason for treatment. Authors report a case of a congenital intrahepatic portosystemic shunt with a hepatic mass that was successfully treated using a percutaneous endovascular approach with vascular plugs. By the time the first short-term follow-up was conducted, the hepatic mass had disappeared.

Keywords: Liver neoplasm; Portosystemic shunt, surgical; Radiology, interventional.

Fig. 1

Congenital intrahepatic portosystemic venous shunt and liver mass in child patient. A. Contrast-enhanced multidetector CT scan performed before embolization revealed 3.5 cm mass with heterogeneous enhancement in liver's right lobe. B. Right anterior oblique digital subtraction direct portogram demonstrated direct connection between dilated left portal vein and left hepatic vein by three variable shunt channels. Right portal vein was very small, compared to left portal vein. C. Right anterior oblique digital subtraction direct portogram immediately after embolization showed successful occlusion of intrahepatic portosystemic shunt and improvement of flow through right portal vein. D. Oblique coronal reformatted CT scan image one month after procedure showed markedly increased size of right portal veins, compared to B.