Radiological and surgical differences between congenital end-to-side (Abernethy malformation) and side-to-side portocaval shunts
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In brief
In brief
Retrospective analysis of 9 pediatric patients with retrohepatic portocaval shunts comparing radiological and surgical features of end-to-side versus side-to-side variants. CT imaging and angiography with occlusion testing reliably distinguished the two types based on portal vein anatomy, caudate lobe presence, and intrahepatic branch development, guiding surgical management decisions.
Written by the GCMD Library team from the article.
Objective
Distinguishing retrohepatic end-to-side portocaval shunts (ES-PCS) and side-to-side portocaval shunts (SS-PCS) can be difficult, but it is essential for determining the treatment strategy. Our experience with retrohepatic PCS is analyzed.
Methods
Since 2007, 9 children (5/9 ES-PCS and 4/9 SS-PCS) were surgically treated. Radiology studies included Doppler-ultrasound, CT/MRI and angiography/occlusion test (8/9).
Results
CT in 5/5 ES-PCS revealed the portal vein (PV) entering the left side of the vena cava with a uniform shape. 4/4 SS-PCS showed aneurysmal PV containing the origin of the main intrahepatic portal branches (IHPB) entering the cava anterior aspect or slightly to the right with a variable length (from long to short/wide). ES-PCS anatomy showed caudate lobe absence with the fistula entering the left cava aspect free of parenchyma, but anterior through the caudate lobe in SS-PCS. With the angiography/occlusion test, the IHPB was undeveloped in ES-PCS (portal pressure > 38 mmHg) and hypoplasic in SS-PCS (portal pressure