PMC8639160_01
Congenital visceral vascular variation was diagnosed by multi-imaging examinations. (a) Tumor-like expansion of the main portal vein and the left branch of the portal vein shown by color Doppler ultrasound. (b) Contrast-enhanced computed tomography scan showed the left hepatic artery (black arrow) and left gastric artery (not shown) co-trunk, as the first branch of the aorta (arrowhead). The common hepatic artery (straight solid arrow) and splenic artery (hollow arrow) originated from the front wall of the aorta below the left hepatic-gastric trunk, while the right hepatic artery (curved arrow) originated from the superior mesenteric artery (right angle arrow). (c) Angiogram showed the common hepatic artery (straight solid arrow). (d) Angiogram showed the fistula (the tiny blood vessels between the two black arrows). (e) Angiogram showed that the right hepatic artery (curved arrow) originated from the superior mesenteric artery (right angle arrow). (f) The position of the occluder (red arrow) was normal and the fistula was completely closed, 3 months after surgery.
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Color Doppler ultrasound revealed a common trunk of the common hepatic artery and splenic artery originating from the anterior wall of the aorta, and the common hepatic artery was directly merged into the portal vein (Figures 1b-e). There was a tumor-like expansion of the main portal vein and the left branch of the portal vein, which were about 124 x 56 x 33 mm and 97 x 55 x 42 mm, respectively (Figure 1a). Computed tomography angiography confirmed the ultrasound findings, and other variant arteries were found (Figure 1b). The occluder was placed at the arterial end of the common hepatic artery-portal vein fistula (Figure 1f). Ultrasound examination showed that the position of the occluder was normal, and the fistula gradually became smaller until it closed completely (Figure 1f).