PMC6180879_01
(a) An oblique sonogram of the upper abdomen shows the hypoplastic portal vein (arrow) arising from the splenomesenteric confluence (asterisk). (b) The transverse sonogram shows the shunt vessel (arrowhead) from the splenomesenteric confluence (asterisk) extending posterior to the pancreas and lying along the left side of the aorta. A, aorta; LGA, left gastric artery; LGV, left gastric vein; P, pancreas; SA, splenic artery; SV, splenic vein.
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fig1
Incidentally, he was found to have a small-sized portal vein arising from the side of the splenomesenteric venous confluence (Figure 1a). There was a vessel noted along the left side of the aorta (Figure 1b).
Duplex Doppler sonography in longitudinal axis shows the shunt vessel (arrowhead) with pulsatile flow owing to the transmitted cardiac periodicity. Flow direction is towards the left renal vein. LRV, left renal vein,; SA, splenic artery; SV, splenic vein.
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fig2
Duplex Doppler sonography showed venous flow towards the left renal vein (Figure 2).
(a) The left hepatic artery (long arrow) arises from the LGA and runs through the fissure of the ligamentum venosum and is termed the RLHA. (b) The right hepatic artery (short arrow) arises from the SMA and is termed the RRHA. A, aorta; IVC, inferior vena cava; LGA, left gastric artery; RLHA, replaced left hepatic artery; RRHA, replaced right hepatic artery; SMA, superior mesenteric artery; SMV superior mesenteric vein.
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fig3
The left hepatic artery originated from the left gastric artery (Figure 3a) and the right hepatic artery from the superior mesenteric artery (Figure 3b).
Schematic illustration of the anomaly shows the hypoplastic portal vein, shunt vessel connecting the splenomesenteric confluence with the left renal vein (Type II extrahepatic portosystemic shunt), the left hepatic artery originating from the left gastric artery (replaced left hepatic artery) and the right hepatic artery originating from the superior mesenteric artery (replaced right hepatic artery). CA, celiac axis; SA, splenic artery; SMA, superior mesenteric artery; SMC, splenomesentric confluence; SMV, superior mesenteric vein; SV, splenic vein.
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fig4
Schematic illustration of the findings are shown in Figure 4.