Noncirrhotic Extrahepatic Portosystemic Shunt Causing Adult-Onset Encephalopathy Treated with Endovascular Closure

Figure 1

(a) Visceral phase angiography following injection of the splenic artery before occlusion of the portosystemic shunt shows retrograde flow from the splenic vein (white arrows) via an enlarged inferior mesenteric vein (black arrows) via shunt (three dashed arrows) into the systemic venous system. (b) Venous phase volume-rendered (VR) image demonstrates a serpentine vascular shunt (three small arrows) connecting an enlarged IMV (large arrow heads) to the left renal vein via a tortuous shunt (three small arrows). The splenic vein is marked with three two large arrows. Normal appearance of the SMV (dashed arrows). Streak artifact in the portal confluence is due to clips from prior Whipple procedure.

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