Ultrasound with Doppler evaluation of congenital hepatic vascular shunts

Abstract

Congenital aberrant hepatic vascular communications result from intrahepatic or extrahepatic errors in vascular development or involution during the transition from fetal to newborn hepatic circulation. These hepatic vascular shunts can be fortuitously discovered and asymptomatic, or can cause symptoms of varying severity, often presenting diagnostic dilemmas. Some hepatic vascular shunts resolve spontaneously while others require interventional radiologic or surgical closure. Affected patients are often first studied with real-time and Doppler ultrasound, so radiologists should familiarize themselves with the expected ultrasound findings of these vascular shunts for effective diagnosis, triage and management. In this review, the authors focus on ultrasound and Doppler findings of hepatic vascular shunts with underlying embryology, clinical features and management strategies. Broadly, these aberrant hepatic vascular communications include portosystemic venous shunts (which can be intra- or extrahepatic and include persistent patent ductus venosus), arterioportal, arteriovenous or mixed shunts.

A new classification of congenital abnormalities of UPVS: sonographic appearances, screening strategy and clinical significance

“…The prenatal diagnosis of CHPAVF enables better planning of postpartum management. Surgical resection, hepatic artery embolization and hepatic artery ligation have all been said to be important tools in the management of this condition [45][46][47].…”

“…Prenatal ultrasound with Doppler might show single or multiple direct communications between the hepatic artery and the portal vein branches. Additional findings include hepatic artery enlargement, portal vein dilatation at the site of fistula, and abdominal aorta tapering beyond the celiac artery [ 45 ]. The main clinical symptoms of CHPAVF are shortness of breath, malaise, poor appetite and watery diarrhea [ 46 ].…”

Pediatric Mesenteric Vasculature: Noninvasive Imaging and Catheter Arteriography

“…1 In addition, awareness of the presence and types of congenital portosystemic shunts is crucial, as Doppler evaluation of these lesions is important for diagnosis, assessment of associated lesions, treatment planning, and follow-up. 5 It is also worth noting that hepatic venous flow may not be triphasic in normal infants; a monophasic pattern is not abnormal (►Fig. 2).…”

Symptomatic congenital hemangiomatosis in a neonate: Imaging of a life-threatening presentation with multifocal liver involvement

“…Since the liver is the most commonly involved site following the skin, once >5 cutaneous hemangiomas are present screening abdominal ultrasound is recommended [3] . The degree of liver parenchyma involvement differentiates three hepatic hemangiomas’ subtypes: focal, multifocal, and diffuse.…”

“…Most congenital hepatic hemangiomas are unifocal [3] . Hepatic hemangiomas’ clinical presentation varies from innocuous to life-threatening.…”