Total Pageviews

Monday 25 May 2015

CASE 315: SPONTANEOUS PORTO-SYSTEMIC SHUNT, Dr PHAN THANH HAI, Dr NGUYEN THI ANH HONG, Dr LE THONG NHAT, Dr TRAN LAM

FOR PICTURES PLS CONNECT TO 3G / DOWNLOAD THE LINK

case 315

Woman  63 yo,  5 years ago  had been treated  diabetes  not  control blood  sugar. Patient  has  some  subcoma  crisii that had been treated in many  hospitals, now she  is in somnolence, easy in sleeping  after eating but cannot sleep at night.
MRI of  the brain, radiologist  detected  hyperintense  T1 at basal ganglion area, susgested  hepato-encepalopathy (image MRI).


Checking  the liver by blood tests, liver function is still good,  but ultrasound of  liver  detected  porta-systemic shunting  very high flow ( see US image 1 dilatation cystic  intrahepatic, US 2, color Doppler:  porta-systemic shunting and US video).





MSCT angio of  liver with  3 phases: arterial phase shows that not abnormal ; venous  phase : dilated  the  porta-systemic  anastomosis like snake. In 3D CT reconstruction  confirmed a  high flow porta-systemic shunting).





Bood test reports  this time  no ceton, high NH3 = 88.89 micromol/mL (normal  18-72).
Conclusion: It is  a high flow  spontaneous  porta-systemic  shunting appeared as hepatic encephalopathy in clinical examination.

REFERENCE:

No comments :