PMC3440936_01
An 89-year-old female with portal vein aneurysm. (a) Coronal Half Fourier Acquisition Single shot Turbo spin Echo (HASTE) image and (b) magnetic resonance cholangiopancreatography (MRCP) image show a 4.8 cm long smooth narrowing of the common bile duct (arrow) at and superior to the porta hepatis secondary to mass effect from the large portal vein aneurysm. Mild intrahepatic biliary ductal dilation was present which is not well appreciated on these images. Marked splenomegaly was present related to portal hypertension from underlying myelofibrosis. No ascites was seen.
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F1
On axial and coronal T1- and T2-weighted images, a large elliptical flow void was noted at the porta hepatis which on post gadolinium dynamic sequences showed enhancement similar to adjacent venous structures [Figures 1 and 2].
An 89-year-old female with portal vein aneurysm. (a) Axial T2-weighted and (b) post gadolinium T1-weighted MR images show a large enhancing aneurysm of the main portal vein (enhancing to the same degree as the IVC (inferior vena cava) and splenic vein) (asterix), causing extrinsic mass effect on the adjacent common bile duct with narrowing.
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F2
On axial and coronal T1- and T2-weighted images, a large elliptical flow void was noted at the porta hepatis which on post gadolinium dynamic sequences showed enhancement similar to adjacent venous structures [Figures 1 and 2].
An 89-year-old female with portal vein aneurysm. (a) Color Doppler and (b) duplex US images show a large elliptical aneurysm of the main portal vein with turbulent to and fro flow (Ying-Yang sign) within the aneurysm.
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F3
Transverse color Doppler US images demonstrated a large aneurysm of the portal vein measuring 3.2 cm in diameter and extending over a length of 4.8 cm, with turbulent flow noted within the aneurysm [Figure 3].
An 89-year-old female with portal vein aneurysm. Endoscopic retrograde cholangiopancreatogram (ERCP) images (a) pre- and (b) post biliary stent placement show a smooth long segment narrowing of the common bile duct (arrow) secondary to the portal vein aneurysm, (not seen on ERCP) treated with endoscopic spincterotomy and biliary stent placement.
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F4
Subsequent ERCP showed mild intrahepatic biliary ductal dilatation with a short segment of smooth significant narrowing of the CHD and proximal CBD secondary to extrinsic mass effect from the portal vein aneurysm [Figure 4].