Large spleno-caval shunt not accompanied by cirrhosis or encephalopathy |
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Authors: | Hiroshi Mitsui Naoaki Hashimoto Masashi Isshiki Naohiko Masaki Akihiko Ohno Hiroshi Imamura Yasushi Harihara Kiyoshi Kurokawa |
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Institution: | (1) First Department of Internal Medicine, Faculty of Medicine, University of Tokyo, 7-3-1 Hougo, Bunkyo-ku, 113 Tokyo, Japan;(2) Second Department of Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113 Tokyo, Japan |
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Abstract: | A 40-year-old man with a large spleno-caval shunt through the azygos vein is described. This was considered a rare case, because
the patient had no accompanying advanced liver disease, or episodes of hepatic encephalopathy. During checks after abnormal
liver function test results, a shunt vessel was detected incidentally by ultrasonography. Computed tomography, magnetic resonance
imaging, and angiography demonstrated that it was a large shunt between the splenic vein and superior vena cava through the
coronary and azygos veins. The patient was a hepatitis B virus carrier and was positive for anti-HBe, and had a history of
heavy drinking. However, on laparoscopic examination, the liver was not cirrhotic and the biopsy revealed only mild chronic
hepatitis without bridging fibrosis. There were no esophageal varices or hepatosplenomegaly. On hemodynamic evaluation, the
wedge hepatic vein pressure was slightly elevated and hepatic blood flow was reduced to half the normal value. Despite the
large portal-systemic shunt, the patient had no history or signs of hepatic encephalopathy. The clinical features of this
rare case are discussed. |
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Keywords: | portal-systemic shunt hepatitis B liver cirrhosis encephalopathy |
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