PMC6759807_01
Computed tomography, esophagogastroduodenoscopy, and portography. (A) Computed tomography showing splenomegaly and signs of cavernous transformation of portal vein. (B) Tomographic reconstruction showing cavernous transformation of portal vein. (C) Esophagogastroduodenoscopy demonstrating gastric varices. (D) Esophagogastroduodenoscopy revealing esophageal varices. (E) Portography before stent placement indicating formation of multiple convolute collateral vessels at hepatic hilus. (F) Patency of portal vein and stent was confirmed by portography after stent placement. Black arrows indicate portal vein. White arrows indicate varices.
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F1
Computed tomography (CT) found esophageal varices and splenomegaly without ascites (Figure 1A). Branches of portal vein were not distinguishable and replaced by multiple convolute collateral vessels, which was consistent with features of CTPV (Figures 1A,B). Esophagogastroduodenoscopy demonstrated grade 3 gastroesophageal varices (Figures 1C,D). Also, splenic vein flowed hepatofugally, and esophageal varices were evidenced (Figure 1E). Patency of portal vein and stent was confirmed by portography afterwards (Figure 1F), and the portosystemic pressure gradient was reduced to 6 mmHg.
Follow-up computed tomography and esophagogastroduodenoscopy at 6 months post-TIPS. (A) Computed tomography showing shunt and smaller size of spleen. (B) Tomographic reconstruction showing stent and portal vein. (C) Esophagogastroduodenoscopy demonstrating relieved gastric varices. (D) Esophagogastroduodenoscopy revealing relieved esophageal varices. Black arrows indicate stent and portal vein.
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F2
The shunt functioned well as determined by ultrasound and CT. The size of the spleen was smaller and the varices were relieved dramatically, determined by CT and the esophagogastroduodenoscopy (Figure 2).