Portal vein aneurysm

[David Patch]

I would be grateful (again) for assistance
64 year old male, asymptomatic, had US for some mild RUQ discomfort. Known portal vein thrombosis and prev variceal bleed >12 years ago. Not on anticoagulation. and he has a 10cm portal vein aneurysm, which is only partially intrahepatic, and compresses his gall bladder. I would like to share the images (he has given his permission) but I dont know how to do that on this platform. Does anyone habe experience of this and more importantly management strategies!

[Dominik Bettinger]

Dear David,
recently, a smiliar patient was refered to our department. The patient was diagnosed with portal vein thrombosis and portal vein aneurysma of 6.5 cm. He presented with variceal bleeding and endoscopic band ligation (EBL) was performed. After another variceal bleeding, we discussed TIPS implantation. During the intervention, we were able to insert a wire into the portal vein, however, we were not able to pass the aneurysma into the splenic vein or the vena mesenterica inferior and we were not able to insert a TIPS stent. Further, after varices had sufficiently been treated with EBL, we started oral anticoagulation. During follow-up CT scans, the thrombosis decreased and the aneurysma shrinked to a diameter of 1,9 cm. During last upper GI endoscopy, the patient showed varices grade I.
If you are interesed, we could share characteristic CT scans.
Best wishes,

Dominik Bettinger
University Medical Center Freiburg, Germany

[David Patch]

Thanks Dominik
This mans aneurysm has grown so I am not sure we can offer anticoagulation. It really is quite n image-with some intrahepatic vessels seeing to eminate from it.

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