CASE 315 : SPONTANOUS PORTOSYSTEMIC SHUNT, Dr PHAN THANH HẢI
CASE 315 SPONTANEOUS PORTO-SYSTEMIC SHUNT, Dr PHAN
THANH HAI, Dr NGUYEN THI ANH HONG, Dr LE THONG NHAT, Dr
Woman 63 yo 5 years ago had been treated diabetes not control
blood sugar. Patient has some subcoma crisii that had been treated in
many hospitals, now she is somnolent, easy in sleeping after eating.but
cannot sleep at night.
MRI of the brain, radiologist detected hyperintense T1 at basal ganglion
area, suggested hepato-encepalopathy (image MRI).
Checking the liver by blood tests, liver function is still good, but ultrasound
of liver detected porta-systemic vein shunting in very high flow ( see US
image 1 dilatation cystic intrahepatic, US 2, color Doppler: porta-systemic
shunting and US video)
MSCT angio of liver with 3 phases: arterial phase shows that not
abnormal; venous phase : dilated the porta-hepatic anastomosis like
snake. In 3D CT reconstruction confirmed a high flow porta-systemic
Bood test reports at this time no ceton , high NH3 = 88,89 mmol/mL
Conclusion: It is a high flow spontaneous porta-systemic shunting
appeared as hepatic encephalopathy in clinical examination.