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Intraluminal duodenal diverticulum is a rare congenital anomaly consisting of a saclike projection within the duodenum. Small diverticula may be asymptomatic; however, when these enlarge, patients may develop recurrent episodes of pain, obstruction, or pancreatitis. Normally, the diagnosis is made by barium luminal examination. We report a case where the findings were seen on computed tomography and confirmed by upper gastrointestinal series.

A patient developed acute severe hemodynamic compromise during a transjugular intrahepatic portosystemic shunt (TIPS) procedure for intractable ascites. Rapid clinical and radiographic evaluation of the patient disclosed pericardial blood and cardiac tamponade as the cause, probably due to right heart perforation from guidewire and catheter manipulation. The tamponade was successfully treated percutaneously, and the patient survived. Cardiac tamponade should be considered in the differential diagnosis of patients who develop hypotension during TIPS placement.

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