In Reply to: Case 0498_09 --Hepatic vein occlusion posted by Editor on March 31, 1998 at 14:49:30:
This looks like a case of chronic Budd-Chiari which is more suitable for TIPS. It may be technically difficult but certainaly duable. Surgical shunt is an option but riskier. Because TIPS has been successful there aren't many surgeons around that are experienced enough to perform shunts. Spiral CT to demonstrate the portal venous anatomy would be helpful. The round structure shown in one of the films could be part of the portal system which could be flowing hepatofugal or have slow ambiguous flow. Venous aneurysm is less likely.
Reference:
Blum U; Rossle M; Haag K; Ochs A; Blum HE; Hauenstein KH; Astinet F; Langer M. Budd-Chiari syndrome: technical, hemodynamic, and clinical results of treatment with transjugular intrahepatic portosystemic shunt. Radiology, 1995 Dec, 7(3):805-11.