Presentation
Known case of cryptogenic cirrhosis from 10 years ago referred with progressive deterioration of hepatic function and hepatic encephalopathy.
Patient Data
The liver has a nodular surface and atrophic, in keeping with cirrhosis
Splenomegaly
Patent portal vein as well as splenic and SMV
Minimal ascetic free fluid
Multiple esophageal collaterals continuing along the cardia to form collaterals in the lesser curvature of the stomach
Gastroesophageal collateral draining into the main portal vein next to hepatic hilum
Multiple tortuous dilated splenic collateral veins draining into the left common iliac vein
Recanalized dilated paraumbilical vein with downward courses along with anterior abdominal wall and drained into the left external iliac vein
Intrahepatic portosystemic venous shunt in the subcapsular area of the liver segment IVa
No communication between the splenic vein and the left renal vein
Right-sided pleural effusion.
Case Discussion
Liver cirrhosis is associated with progressive portal hypertension followed by the formation of portosystemic shunts in order to reduce the portal pressure, but also act as bypasses to normal liver flow. when the shunts enlarged enough, complications including variceal bleeding, hepatic encephalopathy, deterioration of liver function and, portal vein thrombosis will appear.
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