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Hepatic Encephalopathy due to Intrahepatic Portosystemic Shunt via Right Adrenal Vein in a Non-Cirrhotic Patient

Published:December 05, 2020DOI:https://doi.org/10.1016/j.jemermed.2020.10.025
      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 (
      • Tsitouridis I.
      • Sotiriadis C.
      • Michaelides M.
      • Dimarelos V.
      • Tsitouridis K.
      • Stratilati S.
      Intrahepatic portosystemic venous shunts: radiological evaluation.
      ). Common PSSs include gastrorenal, splenorenal, or paraumbilical shunts. However, intrahepatic PSSs via the right adrenal vein have been reported rarely (
      • Ito K.
      • Fujita T.
      • Shimizu A.
      • Sasaki K.
      • Tanabe M.
      • Matsunaga N.
      Imaging findings of unusual intra- and extrahepatic portosystemic collaterals.
      ,
      • Murata S.
      • Sato Y.
      • Inaba Y.
      • et al.
      Intrahepatic portosystemic venous shunt via the right adrenal vein: treatment with vascular plug.
      ). 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.
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