Aneurysmal intraheptic portosystemic venous shunt associated with idiopathic portal hypertension: A lesion evaluated by a 3D image reconstructed from power doppler flow imaging

We used computed-tomography, three-dimensional power Doppler flow imaging, percutaneous transhepatic portography, and histology to examine a 55-year-old Japanese woman with an enormous aneurysmal intrahepatic portosystemic venous shunt (IPVS) associated with idiopathic portal hypertension (IPH) and rheumatoid arthritis. The patient showed clinical evidence of portal hypertension but had neither episodes of hepatic encephalopathy nor risky esophagogastric varices. The intrahepatic venous shunting may have had a therapeutic effect on her portal hemodynamics, thereby preventing formation of risky varices. To our knowledge, this is the first reported case of definite IPH accompanied by an aneurysmal IPVS. Three dimensional power Doppler flow imaging using a magnetic field was useful in reconstructing the 3D image of the aneurysmal IPVS.