PMC8581033_01
The contrast-enhanced CT showed massive pleural effusion on the left chest (A), multiple calcified hilar lymph nodes (B), CTPV [(C), black arrowheads] and distal portal venous aneurysm [(D), star] due to lymphadenopathy [(D), white arrowheads].
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F1
Contrast-enhanced computed tomography (CT) suggested massive pleural effusion on the left chest (Figure 1A), swollen and thickening peritoneum, and multiple enlarged and calcified lymph nodes located at porta hepatis and peripancreatic regions (Figure 1B). The portal venous stenosis resulted in cavernous transformation of portal vein (CTPV), distal portal venous aneurysm, and enlarged spleen with dilated splenic vein (Figures 1C,D).
The contrast-enhanced CT revealed that pleural effusion disappeared (A) but CTPV [(B), arrowheads] was not improved after ATT. CTA with three-dimensional reconstruction showed severe stenosis of main portal vein (C,D).
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F2
ESR and CRP returned to the normal range and chest CT revealed the effective control of pleural effusion (Figure 2A). CT angiography (CTA) with three-dimensional reconstruction showed severe stenosis of main portal vein constricted by the calcified lymph nodes (Figures 2B-D). Considering the poor response of the vascular complication to ATT, portal venous angioplasty by balloon dilation and stent implantation was performed via percutaneous transhepatic approach.
Portal venography showed the main portal vein underwent severely stenosis to be nearly occlusion at the hepatic hilum (A), and distal portal vein distributed abundant varices to encompass the hepatic hilum (B). After portal venous angioplasty by balloon dilation (C) and stent implantation (D), portal vein at the hepatic hilum was clearly displayed, and collateral varices disappeared.
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F3
Besides, portal vein at the hepatic hilum was clearly displayed, and collateral varices could not be seen after the procedure (Figure 3).