PMC10196388_01
Abdominal ultrasound and contrast-enhanced computed tomography (CT) were performed before interventional therapy. (A) Grayscale indicates the largest hepatic nodule (arrows) with clear boundary and inferior vena cava (IVC) compression; (B) left portal vein directly communicated with IVC (arrows); (C) color Doppler ultrasound image confirmed PV flow toward IVC, with a flow velocity of 98 cm/s in the shunt; (D) contrast-enhanced CT showed the presence of direct communication between PV and IVC (arrows).
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Abdominal US examination revealed multiple hepatic nodules with a maximum size of 4.0 x 3.1 cm ( Figure 1A ), clear boundary, and non-uniform internal echo, leading to local inferior vena cava (IVC) compression. The following notable findings were reported: the left PV (LPV) directly communicated with IVC (1.2 cm in diameter); color Doppler US confirmed the PV flow toward IVC ( Figure 1B ), the flow velocity in the shunt was 98 cm/s ( Figure 1C ), the right PV (RPV) was not shown, and no abnormal echo was observed in IVC; and splenomegaly (2 cm below the ribs). Children's Hospital, Zhejiang University School of Medicine to perform contrast-enhanced CT, which confirmed the presence of direct communication between PV and IVC ( Figure 1D ). Contrast-enhanced CT revealed the presence of hepatic nodules, which were misinterpreted as hemangiomas.
Abdominal ultrasound and contrast-enhanced computed tomography (CT) reexamination were performed 3 years after the interventional therapy. (A) Grayscale indicates the complete disappearance of multiple intrahepatic nodulars (LPV: left portal vein, GB: gall bladder); (B) hyperechogenicity between LPV and inferior vena cava (arrows); (C) color Doppler ultrasound image showed bidirectional venous waves in the intraportal spectrum; (D) contrast-enhanced CT on this reconstructed coronal view showed annular metal density shadows in the hilum of the liver (arrows).
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Abdominal US revealed the complete disappearance of multiple FNH/NRH ( Figure 2A ), and the diameter of LPV was 1.3 cm, with a hyperechoic area of 2.1 x 1.3 cm between LPV and IVC ( Figure 2B ). CT examination confirmed that this hyperechoic area was a metal occluder placed after the interventional therapy. Color Doppler US showed bidirectional venous waves in the intraportal spectrum ( Figure 2C ). Abdominal contrast-enhanced CT revealed normal liver size and shape, without local density abnormality and with annular metal density shadows in the hilum of the liver 3 years after the interventional therapy ( Figure 2D ).
The flowchart from disease discovery to patient diagnosis and treatment.
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The process of disease discovery to patient diagnosis and treatment is shown in  Figure 3  as a flowchart.