Ultrasonography and 3D-CT Follow-Up of Extrahepatic Portal Vein Aneurysm: A Case Report

Abstract

Extrahepatic portal vein aneurysm is a rare disorder. From 1956 to 2008, we found only 43 published English-language reports, including 67 cases, using Pub Med. We report a case of a 77-year-old woman who had complaints of lower abdominal fullness and residual urine. We performed ultrasonography (US), which demonstrated a congenital extrahepatic portal vein aneurysm. She had no obvious symptoms of the extrahepatic portal vein aneurysm. She had undergone gastrectomy without blood transfusion for gastric ulcer more than 20 years ago. Physical examination revealed no abnormal findings. US revealed a 2.2 × 1.8 cm, round shaped hypoechogenic lesion at the hepatic hilum. Color Doppler US showed bidirectional colors due to circular flow within this lesion. 3D-CT and CT angiography demonstrated that the saccular aneurysm at the hepatic hilum was 3.0 cm in diameter and was enhanced equal to that of portal vein.Twenty-six months after the diagnosis, the aneurysm had not grown in size. Since our patient had no serious complaints or liver disease, surgical procedures had not been employed. US and 3D-CT are noninvasive diagnostic techniques and are helpful in the diagnosis and follow-up of extrahepatic portal vein aneurysms.

Thrombosed congenital extrahepatic portal vein aneurysm in an infant

“…The congenital origin is supported by the presence of the aneurysms in children and young adults without portal hypertension and liver disorder [1][2][3][4][5][6][7]. A proposed pathogenesis of this congenital form is congenital weakness of the venous wall.…”

“…Normal portal vein diameters in children range from 3 mm to 11 mm [6]. In fact, Yukawa et al [1] reported that the size of EPVA ranged from 8 mm to 115 mm in 68 cases ages between 0 and 83 years. The size of EPVA on the first day of life was measured to be 1.5 cm on US [4].…”

“…In utero diagnosis of a portal vein aneurysm is further evidence of the congenital theory [4,7]. On the other hand, the acquired lesions are secondary to chronic liver disease, portal hypertension, trauma, and pancreatitis [1][2][3]5]. There is no apparent gender predominance in patients with portal vein aneurysms [2,3].…”

“…For patients with asymptomatic EPVA, careful long-term follow-up is recommended [1][2][3][4][5]. In one report [5], two adults with thrombosed EPVA had a stable clinical course.…”

“…Since 1956, when the first case was reported, only 67 cases have been described in the literature [1]. EPVA in infants is extremely rare.…”