Intrahepatic Portosystemic Shunt via the Right Adrenal Vein in an Asymptomatic Cirrhotic Patient

Abstract

Purpose: Intrahepatic portosystemic shunts (PSSs) draining to the inferior vena cava (IVC) via the right adrenal vein has been reported as very rare, and all the patients who have been recorded have had hepatic encephalopathy. Here, we present a patient with intrahepatic PSS via the right adrenal vein diagnosed incidentally without encephalopathy. Case Presentation: A 51-year-old patient, who was diagnosed with chronic liver parenchyma disease and a suspecting nodule on the ultrasound was examined by computed tomography (CT) and magnetic resonance imaging (MRI). A 4 cm in diameter hepatocellular carcinoma (HCC) was detected. In addition to HCC, an abnormal shunt between the right posterior portal vein and the IVC via the right adrenal vein was also detected. Results: To the best of our knowledge, this is the first case with intrahepatic PSS via the right adrenal vein diagnosed incidentally in the absence of encephalopathy and the fourth case with this abnormal shunt in English literature. Conclusions: Intrahepatic PSS via the right adrenal vein is rare. It may be asymptomatic at the time of diagnosis but has the potential to cause various problems, later on, especially hepatic encephalopathy. The radiologist must be aware of this abnormal shunt.