Portal Venous Aneurysm

HomeRadiologyVol. 307, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyPortal Venous AneurysmTara Murty , Lindsey NegreteTara Murty , Lindsey NegreteAuthor AffiliationsFrom the Department of Radiology, Stanford University School of Medicine, 265 Campus Dr, Room G2105, Palo Alto, CA 94305.Address correspondence to T.M. (email: [email protected]).Tara Murty Lindsey NegretePublished Online:Feb 7 2023https://doi.org/10.1148/radiol.221311MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 28-year-old man with history of obesity and nonalcoholic fatty liver disease presented with complaints of abdominal discomfort for several months. An abdominal US demonstrated an aneurysmal dilatation of a vessel adjacent to the pancreatic head. CT angiogram was completed for further characterization and revealed the aneurysm in question to be arising from the portosplenic confluence. No evidence of aneurysm rupture, thrombosis, or associated pancreatitis was present (Figs 1, 2; Movie).Figure 1: Images in a 28-year-old man with complaints of abdominal discomfort. Portal venous (A) coronal and (B) sagittaCT scans show the abdomen with intravenous contrast material, a large aneurysm (arrows) with aneurysm neck (arrowhead) arising from the portosplenic confluence, and main portal vein (*).Figure 1:Download as PowerPointOpen in Image Viewer Figure 2: Static virtual three-dimensional reconstruction shows the portal venous varix (arrow).Figure 2:Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: 28-year-old man with complaints of abdominal discomfort. CT of the abdomen with IV contrast, portal venous phase. A rotating 3D reconstruction demonstrating the portal venous aneurysm.Download Original Video (13.0 MB)A portal vein aneurysm can be congenital or acquired, such as in the setting of severe pancreatitis, trauma, or malignant tumor invasion. The majority of portal vein aneurysms are extrahepatic, and common locations include the splenomesenteric venous confluence, main portal vein, and intrahepatic portal vein branches. Morphologically, these aneurysms are most commonly fusiform but can be saccular. Size criteria for portal vein aneurysm diagnosis is greater than 15 mm for normal liver and 19 mm when cirrhosis is present. Complications include thrombosis, rupture, and mass effect on adjacent structures. Evidence indicates that rupture risk is low due to low portal venous pressure; however, risk is increased in the presence of portal hypertension. No defined management guidelines currently exist. In this case, the patient elected for imaging surveillance (1–4).Disclosures of conflicts of interest: T.M. No relevant relationships. L.N. No relevant relationships.AcknowledgmentThe authors thank Brian Pogatchnik, MD.References1. Laurenzi A, Ettorre GM, Lionetti R, Meniconi RL, Colasanti M, Vennarecci G. Portal vein aneurysm: What to know. Dig Liver Dis 2015;47(11):918–923. Crossref, Medline, Google Scholar2. Rafiq SA, Sitrin MD. Portal vein aneurysm: case report and review of the literature. Gastroenterol Hepatol (N Y) 2007;3(4):296–298. Medline, Google Scholar3. Lau H, Chew DK, Belkin M. Extrahepatic portal vein aneurysm: a case report and review of the literature. Cardiovasc Surg 2002;10(1):58–61. Crossref, Medline, Google Scholar4. Cho SW, Marsh JW, Fontes PA, et al. Extrahepatic portal vein aneurysm--report of six patients and review of the literature. J Gastrointest Surg 2008;12(1):145–152. Crossref, Medline, Google ScholarArticle HistoryReceived: May 26 2022Revision requested: Aug 18 2022Revision received: Oct 12 2022Accepted: Oct 28 2022Published online: Feb 07 2023 FiguresReferencesRelatedDetailsRecommended Articles Portal Interventions in the Setting of Venous Thrombosis or OcclusionRadioGraphics2022Volume: 42Issue: 6pp. 1690-1704A Comprehensive Approach to Hepatic Vascular DiseaseRadioGraphics2017Volume: 37Issue: 3pp. 813-836Vascular Anomalies of the Pediatric LiverRadioGraphics2019Volume: 39Issue: 3pp. 842-856Portal Venous Interventions: State of the ArtRadiology2016Volume: 278Issue: 2pp. 333-353Transsplenic Portal System Catheterization: Review of Current Indications and TechniquesRadioGraphics2022Volume: 42Issue: 5pp. 1562-1576See More RSNA Education Exhibits Current Multimodality Imaging Assessment of the Portal Venous System: A Pictorial EssayDigital Posters2020Vascular Complications of Pancreatitis: The Common, the Obscure, and the DeadlyDigital Posters2019Portal Vein Potpourri: From Thrombosis to TherapyDigital Posters2019 RSNA Case Collection Portal vein varixRSNA Case Collection2021Giant extrahepatic portal vein aneurysm RSNA Case Collection2020Pancreatic Pseudocyst to Portal Vein FistulaRSNA Case Collection2021 Vol. 307, No. 2 Metrics Altmetric Score PDF download