Successful Treatment Using Coil Embolization of a Symptomatic Intrahepatic Portosystemic Venous Shunt Developing through a Patent Ductus Venosus in a Noncirrhotic Adult

Abstract

The patient was a 60-year-old man with encephalopathy without liver cirrhosis. CT angiography revealed a patent ductus venosus between the anterior segmental branch of the portal vein and the middle hepatic vein. Coils were framed in the patent ductus venosus and then used to fill in the frame. After treatment, transarterial portography showed that the shunt flow of the ductus venosus had decreased significantly. After one day, the patient's disturbance of consciousness disappeared. Our case involved the adult-onset of a patent ductus venosus, which is extremely rare. This case is the first in which coil embolization was successfully achieved in a noncirrhotic elderly patient with a patent ductus venosus.

Portosystemic Encephalopathy without Liver Cirrhosis Masquerading as Depression

“…According to our literature review, 24 cases of portosystemic encephalopathy without liver cirrhosis have been reported, including 20 from East Asia (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and four from the USA (16)(17)(18)(19), since Raskin et al reported the first case in 1964 (16). Previous studies involved mostly women (83%), with a mean age of 67.5 years (range: 37-86 years).…”

Recommendation of Repeated Ammonia Tests for Intrahepatic Portal-Systemic Shunt Without Cirrhosis in Elderly Patients With Psychiatric Symptoms

“…5 Encephalopathy from IPSSwoC intermittently occurs in the elderly, probably because of the irregular susceptibility of the brain to ammonia by aging. 6,7 To understand the correlation between blood ammonia levels and the PSE, we extracted Japanese congenital or idiopathic PSS without cirrhosis cases from the National Center for Biotechnology Information literature search sites 3,8–20 and estimated grades of PSE based on the symptoms described in them according to the guideline 21 (Table 2). There was a moderate correlation between blood ammonia levels and the estimated grades of PSE of PSS without cirrhosis (Figure 2, r 2 = 0.495).…”

Clinical Significance of Ductus Venosus Waveform as Generated by Pressure- volume Changes in the Fetal Heart

“…A DV flow effect in neonatal liver and its persistence after birth remain an unclear subject [90][91][92]. Few cases have been described so far, and diagnoses occurred not only in early childhood but also in adulthood or even on autopsy studies [93][94][95][96]. The majority appear sporadic, but a recessive genetic heritage has been hypothesized since the description of PDV in three brothers [89].…”

“…representing hepatic, pulmonary and cardiac dysfunction [97][98][99]. Manifestations reported include cholestatic jaundice [93][94][95][96][97][98][99][100], hepatic encephalopathy [91,94,95,99], massive gastrointestinal bleeding [98]; acute liver failure [99,101]; respiratory distress [102] and pulmonary arteriovenous fistulae [103,104], and tumor-like hepatic lesions [92,105]. A child with a single ventricle, who presented with spontaneous microbubbles on echocardiography, was found to have a PDV [106].…”

“…This may reveal or at least raise the suspicion of a portosystemic shunt [91,94,95,97,99,102,103,105,106]. Magnetic resonance angiography has also been suggested as an important diagnostic tool, specifically for infants [108].…”