PMC7739081_01
Coronal contrast-enhanced computed tomographic images in portal venous phase demonstrate hypodense thrombus (red arrows) within the direct intrahepatic portosystemic shunt stent. Note the density of contrast within the inferior vena cava and heart for comparison. There is also marked ascites and patchy enhancement of the liver parenchyma.
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Doppler ultrasound and computed tomography of the abdomen with intravenous contrast were performed shortly after (Figure 1). Despite a therapeutic INR, both modalities were confirmed in stent thrombosis.
(a) A pre-AngioJet fluoroscopic image with a catheter through the DIPS stent from a right internal jugular approach. Contrast has been injected into the splenic vein, demonstrating some filling of small splenic collaterals but no flow through the DIPS. (b) A digital subtraction angiogram demonstrating flow through the portal vein, DIPS shunt, and into the right atrium after treatment. DIPS = direct intrahepatic portosystemic shunt.
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He was admitted to hospital 1 week later for PMT with the AngioJet system (Figure 2).