PMC5109562_01
(a) Clinical course during the first admission. (b, c) Abdominal computed tomography (CT) on admission. (b) A transverse CT view through the middle abdomen shows liver cirrhosis, enlargement of the caudate lobe of the liver, and ascites (arrows: thrombi). (c) A coronal view of the middle abdomen shows thrombosis in the left hepatic vein (LHV) and stenotic inferior vena cava (IVC) with a thrombus. (d, e) Angiography of the abdominal veins. (d) The IVC was stenotic; the pressure in the IVC was 17 mmHg, and that in the right atrium was 1 mmHg (arrows: thrombi, triangle: IVC stenosis). (e) The LHV was obstructed with spider-like collateral formation and thrombosis; Budd-Chiari syndrome was diagnosed (arrows: thrombus). CyA: cyclosporin A, ALB: albumin, PLT: platelets, RCC: red cell concentrates stored in mannitol-adenine-phosphate solution, BW: body weight
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He was admitted to our hospital to evaluate the weight increase (Fig. 1a). Computed tomography (CT) revealed liver cirrhosis, ascites, and thrombus formation in the left hepatic vein (LHV) and hepatic inferior vena cava with stenosis (Fig. 1b and c). Angiography showed stenosis of the hepatic inferior vena cava and hepatic veins due to thrombosis, with collateral formation (Fig. 1d and e).
(a) Clinical course of the second admission. The abdomen (b) before and (c) 1 month after peritoneovenous shunt (PVS) insertion. (d, e) Abdominal and pelvic CT 4 months after discharge. Some ascites remained 1 month after PVS insertion; however, his distended abdomen was obviously improved. CyA: cyclosporin A, ALB: albumin, PLT: platelets, RCC: red cell concentrates stored in mannitol-adenine-phosphate solution, CT: computed tomography, BW: body weight
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He was re-admitted to our hospital for variceal bleeding on day 165 and endoscopic variceal ligation (EVL) was performed (Fig. 2a). Denver(R) PVS was inserted by a surgeon from the right upper quadrant of the abdomen, subcutaneously through the thorax, and placed via the right internal jugular vein (Fig. 2b). During PVS insertion, warfarin was replaced by heparin. His weight had decreased to 50 kg 1 month after discharge and his distended abdomen was obviously improved with reduced ascites (Fig. 2c). Although his weight had increased slightly 4 months after shunt insertion because his appetite had improved, the ascites was controlled according to abdominal and pelvic CT 4 months after discharge (Fig. 2d and e).