Portal vein aneurysms: imaging manifestations and clinical significance

Abstract

This article will review the computed tomography (CT) findings in patients with portal vein aneurysms (including presentation of several case examples) and discuss imaging criteria and management options. Given the extreme rarity of portal vein aneurysms, as well as a lack of familiarity with the entity on the part of radiologists, the diagnosis can often be overlooked. Appreciation of the most commonly used diagnostic criteria, as well as the role of CT in the appropriate follow-up of these patients, is critical in ensuring appropriate management. In particular, the significance of these aneurysms must be appreciated in the emergency setting, as portal vein aneurysms can rarely present with symptoms of abdominal pain and other complications (such as thrombosis, portal hypertension, rupture, embolism, and compression of the duodenum and inferior vena cava) making surgical repair necessary.

A rare case of huge intrahepatic portal vein aneurysm

“…Congenital factors include an abnormality of the internal walls of the vessel, incomplete regression of the distal right primitive vitellin vein or a variant branching pattern of the portal vein [6]. Portal vein aneurysms may lead urgent surgical operations if they make complications as thrombosis, portal hypertension, rupture, embolism, and compression of the duodenum and inferior vena cava [7]. In this case, the hypothesis of a congenital origin can be suggested because no other cause was found.…”

Thrombosis of a portal vein aneurysm: a case report with literature review

“…This hypothesis is supported by the inutero diagnosis of portal vein aneurysms by US [7], as well as the relative frequent occurrence of this entity in children or healthy young adults [8]. In addition, the presence of PVAs in patients with histologically normal livers (without portal hypertension), as well as the frequent stability of such aneurysms over time, supports a congenital etiology [9].…”

“…The less-frequent locations are the splenic, mesenteric and umbilical vein. Portal venous system aneurysms are more frequently located extrahepatic (63%) compared to intrahepatic, possibly due to the restrictive effects of the liver parenchyma on aneurysm growth [1,4,9]. The main differential diagnoses of portal vein aneurysm are hyperenhancing abdominal tumors or liver or peripancreatic fluid collections [13].…”

“…At MR imaging, there is variable signal intensity in the thrombosed PVA on T1-and T2-weighted images due to ageing blood. Given the extreme rarity of portal vein aneurysms, as well as a lack of familiarity with the entity, the diagnosis can be overlooked [9].…”

An intrahepatic Portal Vein Aneurysm Presenting with Esophageal Variceal Bleeding in a Pediatric Patient: A Rare Clinical Entity

“…Gastrointestinal endoscopic examination performed 3 months after surgery showed regression of the esophageal and fundal varices ( Figure 3a, 3b ). Unfortunately, portal vein thrombosis occurred in the follow-up probably due to venous stasis ( Figure 4a, 4b ) ( 3 ). To our knowledge, there are no studies using large case series and a consensus on the use of anticoagulants in patients with portal vein thrombosis.…”