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Portal Venous System Aneurysms: Imaging, Clinical Findings, and a Possible New Etiologic Factor

¹ All authors: Department of Radiology, Bakent University Faculty of Medicine, Dadalolu Mah., Serin Evler 39 Sok. No 6, Yüreir, 01250 Adana, Turkey.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Two different patients with incidentally discovered portal vein aneurysm. Patient 18 in Tables 1 and 3: 57-year-old man who presented with abdominal wall abscess and gluteal abscess. Oblique transverse thick-slab (35-mm) maximum-intensity-projection contrast-enhanced MDCT image obtained at portal venous phase shows fusiform aneurysmal dilatation of right portal vein (arrow) with maximum diameter of 20 mm.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Two different patients with incidentally discovered portal vein aneurysm. Patient 13 in Tables 1 and 3: 56-year-old woman referred for treatment of microcytic anemia. Oblique sagittal color Doppler sonographic image shows aneurysm of portal vein at bifurcation (arrow) with turbulent flow.

View larger version (190K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Patient 2 in Tables 1 and 3: 81-year-old woman who presented with abdominal pain and was diagnosed as having multiple portal vein aneurysms with recurrent portal vein thrombosis and splenomegaly. Transverse thin-slab (10-mm) maximum-intensity-projection CT image shows aneurysmal dilatation of right portal vein (white arrows) and left portal vein (black arrows), right-sided predominant diffuse calcification, and partial thrombosis of portal vein.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Patient 2 in Tables 1 and 3: 81-year-old woman who presented with abdominal pain and was diagnosed as having multiple portal vein aneurysms with recurrent portal vein thrombosis and splenomegaly. Diffuse calcification of portal venous system is readily identified on arterial portography. Black arrows indicate location of six aneurysmal segments of portal venous system. White arrows indicate inferior margin of main portal vein, portal confluence, and distal splenic vein.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Patient 1 in Tables 1 and 3: 67-year-old woman presenting with fever, nausea, and vomiting who was diagnosed as having multiple aneurysms of portal venous system with thrombophilic defects, recurrent portal vein thrombosis, and splenomegaly. Enhanced oblique transverse thin-slab maximum-intensity-projection (MIP) CT image (A) and coronal curved planar thick-slab MIP CT image (B) trace portal vein. Aneurysms of main portal vein, portal confluence, and splenic vein (arrows) are depicted. Note hypodense area of portal vein thrombosis and hyperdense calcifications.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Patient 1 in Tables 1 and 3: 67-year-old woman presenting with fever, nausea, and vomiting who was diagnosed as having multiple aneurysms of portal venous system with thrombophilic defects, recurrent portal vein thrombosis, and splenomegaly. Enhanced oblique transverse thin-slab maximum-intensity-projection (MIP) CT image (A) and coronal curved planar thick-slab MIP CT image (B) trace portal vein. Aneurysms of main portal vein, portal confluence, and splenic vein (arrows) are depicted. Note hypodense area of portal vein thrombosis and hyperdense calcifications.

View larger version (179K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Three different patients with portal vein aneurysms and different etiologic factors. Patient 17 in Tables 1 and 3: 38-year-old man who presented with abdominal pain and also had liver cirrhosis secondary to hepatitis B, recurrent portal vein thrombosis, and choledocholithiasis. Coronal thick-slab maximum-intensity-projection (MIP) CT image shows multiple aneurysmal dilatations (arrows) and calcifications of portal venous system, atrophic liver, and splenomegaly.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Three different patients with portal vein aneurysms and different etiologic factors. Patient 14 in Tables 1 and 3: 42-year-old woman who presented with abdominal pain and had history of pancreatitis. Transverse curved planar thin-slab (15-mm) MIP CT image shows mild aneurysmal dilatation of portal confluence and distal splenic vein (open arrows), which measure 22 and 23 mm, respectively. Calcified pseudocyst (solid arrows) can be seen anterior to aneurysms.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Three different patients with portal vein aneurysms and different etiologic factors. Patient 10 in Tables 1 and 3: 26-year-old man who presented with difficulty breathing had huge bilateral bullae of lung, thoracic–lumbar rotoscoliosis, multiple endocrine neoplasia syndrome type 1, and cutis laxa. Oblique transverse thick-slab (20-mm) MIP CT image shows fusiform aneurysm, including portal confluence (35 mm) and body (24 mm) of main portal vein (black arrows), in addition to left-sided upper abdominal hypodense mass that was neuroendocrine tumor (white arrows).

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