|IMAGES AND VIDEOS
|Ahead of print publication
Extra-hepatic portal vein aneurysm diagnosed by EUS
Surinder Singh Rana1, Lovneet Dhalaria1, Ravi Sharma1, Rajesh Gupta2
1 Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Surgery, Division of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||31-Mar-2020|
|Date of Acceptance||25-May-2020|
|Date of Web Publication||20-Jul-2020|
Surinder Singh Rana,
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
A 51-year-old female, with no comorbidities and addictions presented with upper abdominal pain for 2 months. Laboratory workup, including both hematological and biochemical parameters were within the normal range. Ultrasound abdomen done elsewhere revealed a 3.8 cm cystic lesion adjacent to the neck of the pancreas, and she was referred to us EUS. EUS confirmed the presence of anechoic lesion adjacent to the neck of the pancreas [Figure 1]: Arrows]. The splenic vein (SV) was seen communicating with this lesion [Figure 1]. Colour Doppler confirmed the presence of flow in this cystic lesion [Figure 2]. The cystic lesion was also seen communicating with the main portal vein (PV), suggestive of PV aneurysm (PVA) located near the confluence of superior mesenteric vein and SV [Figure 3]. Contrast-enhanced computed tomography of the abdomen confirmed the presence of PVA located near the confluence of superior mesenteric vein and SV [Figure 4]. Gastroscopy did not reveal any abnormality, and the patient's abdominal pain responded to 4-week course of proton-pump inhibitor. She continued to be asymptomatic during 18-month follow-up, and ultrasound done 1 year later showed no increase in the size of the PVA.
|Figure 1: Anechoic lesion adjacent to the neck of pancreas (arrows). The SV could be seen communicating with this lesion. SV: Splenic vein|
Click here to view
|Figure 3: EUS color Doppler: The cystic lesion is communicating with main PV. PV: Portal vein|
Click here to view
|Figure 4: Contrast-enhanced computed tomography of abdomen: PVA located near the confluence of SMV and SV. PVA: PV aneurysm, SMV: Superior mesenteric vein, SV: Splenic vein|
Click here to view
PVA is a rare venous malformation, characterized by focal fusiform or saccular dilatation of the PV., Diagnosis is made when PV diameter is >19 mm in cirrhotic patients and 15 mm in noncirrhotic patients. The precise etiology of PVA is not clearly described but is considered to be either congenital or acquired, with cirrhosis being the most common cause of acquired PVA., PVA is most commonly located in the main PV trunk, followed by the confluence of superior mesenteric vein and SV. It can be rarely located at the extrahepatic right or left PV., PVA is usually asymptomatic or present with nonspecific abdominal pain. Occasionally, patients with PVA may present with complications such as thrombosis, complete occlusion of PV, gastrointestinal bleeding, and pressure symptoms like jaundice., PVA is usually diagnosed by abdominal Doppler ultrasonography, and computed tomography/magnetic resonance imaging can help in confirming the diagnosis in case of ambiguous sonography findings. EUS has been rarely used to diagnose PVA, and its detailed findings have not been described in the literature. The natural history of PVA is unclear, and therefore, there is no consensus of its management. Currently, asymptomatic PVA is managed conservatively with serial monitoring, and interventional surgical or endovascular treatment is offered to patients with complicated PVA.,,
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her their images and other clinical information to be reported in the journal. The patient understands that her names and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
The authors would like to acknowledge Dr. Sarakshi Mahajan, Resident, Department of Medicine, Pontiac, MI, USA for proofreading as well as editing the manuscript for the English Language.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
He H, Antonopoulos CN, Moulakakis KG, et al
. Diagnosis and surgical treatment of extrahepatic portal vein aneurysm: A case report. Vascular
Laurenzi A, Ettorre GM, Lionetti R, et al
. Portal vein aneurysm: What to know. Dig Liver Dis
Fujikawa T, Tanaka A, Yoshimoto Y. Enlarged extrahepatic portal vein aneurysm in a non-cirrhotic patient: A therapeutic dilemma. BMJ Case Rep
2011;2011. pii: bcr0620114317.
Salem SB, Aadam AA, Shapiro DM. Aneurysm of the portal vein confluence diagnosed by endoscopic ultrasound. Dig Endosc
[Figure 1], [Figure 2], [Figure 3], [Figure 4]