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Extra-hepatic portal vein aneurysm diagnosed by EUS

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 Submission31-Mar-2020
Date of Acceptance25-May-2020
Date of Web Publication20-Jul-2020

Correspondence Address:
Surinder Singh Rana,
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_40_20

PMID: 32687073

How to cite this URL:
Rana SS, Dhalaria L, Sharma R, Gupta R. Extra-hepatic portal vein aneurysm diagnosed by EUS. Endosc Ultrasound [Epub ahead of print] [cited 2020 Aug 7]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=290106

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

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Figure 2: EUS color Doppler: Flow signal noted in the cystic lesion

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Figure 3: EUS color Doppler: The cystic lesion is communicating with main PV. PV: Portal vein

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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

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PVA is a rare venous malformation, characterized by focal fusiform or saccular dilatation of the PV.[1],[2] Diagnosis is made when PV diameter is >19 mm in cirrhotic patients and 15 mm in noncirrhotic patients.[2] 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.[1],[2] 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.[1],[2] 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.[1],[2] 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.[3] EUS has been rarely used to diagnose PVA, and its detailed findings have not been described in the literature.[4] 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.[1],[2],[3]

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 Top

He H, Antonopoulos CN, Moulakakis KG, et al. Diagnosis and surgical treatment of extrahepatic portal vein aneurysm: A case report. Vascular 2015;23:553-4.  Back to cited text no. 1
Laurenzi A, Ettorre GM, Lionetti R, et al. Portal vein aneurysm: What to know. Dig Liver Dis 2015;47:918-23.  Back to cited text no. 2
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.  Back to cited text no. 3
Salem SB, Aadam AA, Shapiro DM. Aneurysm of the portal vein confluence diagnosed by endoscopic ultrasound. Dig Endosc 2014;26:754-5.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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