Introduction

Portal vein aneurysm is a rare clinical entity, with only 41 published cases in the English-language literature. Twenty-five of them were congenital(₁). Portal venous aneurysms are described as focal dilatations of the portal venous system(₂).Generally it was incidentally diagnosed during an investigation for dyspepsia(₁).

Case Presentation

Our case was a 65-year-old male. He was suffering from flatulance and dyspepsia for 2 years. His past medical history was significant for a blunt trauma to the right upper quadrant of the abdomen he had experienced 19 years ago due to a traffic accident. Upper abdominal ultrasound imaging was carried out for a possible diagnosis of cholelithiasis. A venous aneurysm of 28x24 mm corresponding to the proximal zone of left branch of portal vein next to the falciform ligament. (Figures 1 and 2).

Figure 1

Figure 1

Figure 2

Figure 2

Color Doppler ultrasound imaging revealed venous aneurysmal dilation with continuous flow pattern as in the case with portal flow (Figure 3).

Figure 3

Figure 3

Three phase series magnetic resonance portography showed excessive high signal intensity consistent with an aneurysmal dilation in the proximal zone of left portal vein (Figures 4 and 5).

Figure 4

Figure 4

Figure 5

Figure 5

Main and right portal vein calibrations and hepatic veins were normal. With these findings, conservative follow-up controls with annual abdominal ultrasound and, if necessary, with MR portography was the decision made for this case.

Discussion

Extrahepatic portal vein aneurysm is rare with no more than 50 reported cases in the English literature. This study was to elucidate the procedures used in the diagnosis and management of portal vein aneurysm(₃).

There are two types: intrahepatic and extrahepatic. Portal hypertension is the most important etiologic factor in the development of portal vein aneurysm(₂).

In the study of Koc et al,the prevalence of portal venous system aneurysm among 4,186 consecutive patients was 0.43%. There were no differences with respect to patient age, patient sex, and intrahepatic or extrahepatic location of aneurysm between those with and those without portal venous system aneurysm(₄).

This pathology is increasingly encountered with the frequent use of radiological imaging modalities in the work-up of abdominal disorders(₅).

It appears that these aneurysms can be found at any age and that there is no sexual preference. In most cases these aneurysms are asymptomatic. In rare cases they may cause portal hypertension(₆).Our patient had no signs suggestive of portal hypertension; the lesion was incidentally detected by ultrasound.

Ohnami et al stress the usefulness of color Doppler sonography for studying the hemodynamics of this vascular anomaly and briefly review the literature(₇).

Extrahepatic portal vein aneurysm can be evaluated by US, CT and MRA for optimum conservative or surgical management(₃). Consequently, color Doppler ultrasonography in the demonstration of portal vein aneurysm is highlighted(₂).

Correspondence to

Doç. Dr. Ufuk YETKIN, 1379 Sok. No: 9,Burç Apt. D: 13 - 35220, Alsancak – IZMIR / TURKEY Tel: +90 505 3124906 , Fax: +90 232 2434848 e-mail: ufuk_yetkin@yahoo.fr