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Extrahepatic Portal Vein Aneurysms

Laboratório Fleury São Paulo-SP, 01333-910 Brazil

Portal vein aneurysm is an uncommon finding. Two major causes, congenital and acquired, have been proposed. Strong support is given to the theory that they are acquired because a significant number of portal vein aneurysms are detected in patients with underlying hepatocellular disease and portal hypertension. The congenital cause is supported by the fact that some of the portal vein aneurysms are found in children and young adults who have no evidence of liver disease or portal hypertension. In such patients, the aneurysm results from an inherent weakness of the vessel wall. Convincing evidence of the congenital theory is supported by the in utero diagnosis [1].

An asymptomatic 21-year-old woman presented with abdominal pain and no underlying disease. The physical examination and findings of routine blood and urine tests were unremarkable. Abdominal sonography showed two anechoic oval masslike lesions close to the hepatic hilum. Color Doppler sonography showed complete filling of the lesion with a helical pattern (Fig. 4A). Duplex Doppler sonography showed a monophasic waveform, characteristic of the portal vein, with hepatopetal flow. No portal vein trunk was identified.

View larger version (65K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A. —21-year-old woman with abdominal pain and no underlying disease. Power color Doppler sonography of liver depicts aneurysms at hepatic hilum, with monophasic waveform characteristic of portal vein flow.

Abdominal MR imaging followed by portal vein MR angiography was performed. Axial T1- and T2-weighted images and an axial time-of-flight sequence showed two connected aneurysms of the extrahepatic portal vein and no liver abnormalities (Fig. 4B). MR angiography of the portal vein was performed in the coronal plane after an IV injection of a bolus of doubledose paramagnetic contrast material. This sequence better depicted the aneurysms and some collaterals in the hepatic hilum (Fig. 4C). Maximum-intensity-projection reformation was performed in the axial, sagittal, and coronal planes.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B. —21-year-old woman with abdominal pain and no underlying disease. Axial T1-weighted MR image (TR/TE, 200/4.2; flip angle, 90°) shows bilobulated masslike lesion in hepatic hilum, with helical pattern in central region, reflecting helical flow within aneurysm.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C. —21-year-old woman with abdominal pain and no underlying disease. Coronal three-dimensional MR angiographic maximum-intensity-projection reformation (6/1.9; inversion time, 22; flip angle, 30°) image shows aneurysms. One is in splenomesenteric venous junction; other is in extrahepatic portal vein. Note collaterals in hepatic hilum.

Most reported extrahepatic portal vein aneurysms occur at the confluence of the superior mesenteric and splenic veins. The intrahepatic aneurysms have the tendency to occur at the bifurcations (80% of reported cases) [2]. However, it is uncertain whether confluence and bifurcation are more susceptible to changes in blood pressure than straight vessels [2].

Surgical treatment of portal vein aneurysms depends on the size, symptoms, complications, and clinical condition of the patient [3]. In our patient, because it was an incidental asymptomatic finding having no association with liver disease or portal hypertension, a follow-up study was proposed.

To our knowledge, a double extrahepatic portal vein aneurysm has not been reported. In the past, splenoportography was used to evaluate these aneurysms. Today, however, CT and MR angiography are preferred in most instances because they are less invasive.

References

1. Fulcher A, Turner M. Aneurysms of the portal vein and superior mesenteric vein. Abdom Imaging 1997;22:287-292[Medline]
2. Ohnami Y, Ishida H, Konno K, et al. Portal vein aneurysm: report of six cases and review of the literature. Abdom Imaging 1997;22:281-286[Medline]
3. Brock PA, Jordan PH, Barth MH, Rose AG. Portal vein aneurysm: a rare but important vascular condition. Surgery 1997;121:105-108[Medline]

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This Article Figures Only Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Blasbalg, R. Articles by Tiferes, D. A. Search for Related Content PubMed PubMed Citation Articles by Blasbalg, R. Articles by Tiferes, D. A. Social Bookmarking                      What's this?