An unusual portal-systemic shunt, most likely through a patent ductus venosus-A case report-

Abstract

A 46-year-old alcoholic man with complaints of common cold like symptom and abnormal behavior was admitted to this department. Various investigations indicated advanced liver cirrhosis. Real-time ultrasound in the right intercostal section demonstrated a large conduit continuous from the portal vein to the inferior vena cava through, and behind the liver. Computed tomography revealed a sausageshaped low density channel connecting hepatic hilum and inferior vena cava, and bolus injection contrast enhancement demonstrated transit of contrast medium from the portal vein directly into the inferior vena cava through the sausage-shaped low density channel. Superior mesenteric arteriography demonstrated varicose veins in the hilar regions of the liver in the venous phase.
The catheter introduced into the inferior vena cava for hepatic vein catheterization showed large opening of this portal vena caval shunt.
Measurements of ammonia level and PaO₂ at various levels of the inferior vena cava during the catheterization clearly indicated that portal vein blood was being shunted through this channel.