CT and MRI in the Diagnostics of Intrahepatic Portocaval Shunt. Review of Literature and Case Reports

Purpose: To describe two cases of diagnostic of intrahepatic portacaval shunt based on the computed (CT) and magnetic resonance tomography (MRI). Provide a brief review of the literature on this pathology.

Material and methods: Two case reports of patients with intrahepatic portacaval shunts which were diagnosed by CT and MRI with contrast enhancement.

Results and discussion: A peculiarity of the presented case reports was that in both cases the patients had oncopathology and were examined for the purpose of staging the disease. Due to the risk of cancer when analyzing CT and MRI images, focal changes in the liver can be mistakenly interpreted as metastases. In various situations, the attending physician may choose tactics for further observation, or decide to verify the identified changes in the liver. In the latter case, minimally invasive intervention can damage the shunt wall and cause bleeding. To avoid any complications, the radiologist have to identify and interpret vascular abnormalities in the liver confidently and unambiguously. The two presented case reports demonstrated typical signs of an intrahepatic porthocaval shunt, both according to CT and MRI. These include the connection of the lesion with the main vessels with similar dynamics of contrast enhancement, and the absence of signs of diffusion restriction.

Conclusion: The presented semiotics of the intrahepatic portacaval shunt according to CT and MRI data allows to diagnose it confidently and thus avoid the need for repeated studies or surgical intervention.