Hepatic encephalopathy is a common sequela in cirrhotic patients, presenting with
a range of neurologic and psychiatric symptoms accompanied by hyperammonemia. This
disorder can occur in non-cirrhotic patients with a predisposing factor—portosystemic
shunts (PSSs) —which are challenging to diagnose. Understanding the anatomic courses
of PSSs can facilitate their diagnosis. PSSs can be classified as intrahepatic or
extrahepatic, depending on whether the shunts originate from intrahepatic or extrahepatic
portal veins (
1
). Common PSSs include gastrorenal, splenorenal, or paraumbilical shunts. However,
intrahepatic PSSs via the right adrenal vein have been reported rarely (
2
,
3
). Therefore, in this report, we present a non-cirrhotic patient with hepatic encephalopathy,
with imaging results suggesting an intrahepatic PSS via the right adrenal vein.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intrahepatic portosystemic venous shunts: radiological evaluation.Diagn Interv Radiol. 2009; 15: 182-187
- Imaging findings of unusual intra- and extrahepatic portosystemic collaterals.Clin Radiol. 2009; 64: 200-207
- Intrahepatic portosystemic venous shunt via the right adrenal vein: treatment with vascular plug.Minim Invasive Ther Allied Technol. 2017; 26: 51-55
- Hepatic encephalopathy in patients with non-cirrhotic portal hypertension: description, prevalence and risk factors.Dig Liver Dis. 2016; 48: 1072-1077
- Systematic review of congenital and acquired portal-systemic shunts in otherwise normal livers.Br J Surg. 2014; 101: 1509-1517
- Congenital portosystemic venous shunt.Eur J Pediatr. 2018; 177: 285-294
- Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause.J Clin Ultrasound. 2006; 34: 22-26
- Intrahepatic portosystemic venous shunt.AJR Am J Roentgenol. 1990; 155: 527-528
- Intrahepatic portosystemic venous shunts: spectrum of ct findings in external and internal subtypes.J Comput Assist Tomogr. 2001; 25: 348-354
Article info
Publication history
Published online: December 05, 2020
Accepted:
October 4,
2020
Received in revised form:
September 16,
2020
Received:
September 4,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
