Portal vein aneurysm-etiology, multimodal imaging and current management

Thrombosed massive portal vein aneurysm in an adolescent boy

Portal vein aneurysm is a rare vascular disorder, particularly in the pediatric population, with relatively few cases reported in the literature. The most frequent complication of portal vein aneurysm is thrombosis, which may lead to diagnostic uncertainty as it can resemble a tumor. Therefore, it is important to recognize this entity and its imaging features for accurate diagnosis. We present a case of a portal vein aneurysm in an adolescent boy, complicated with thrombosis, and report radiological findings, treatment, and short-term follow-up.

Asymptomatic Portal Vein Aneurysm Uncovered During the Evaluation of a Gastrointestinal Hemorrhage: A Rare Clinical Case

Portal vein aneurysms (PVAs) are rare vascular anomalies that are most often discovered incidentally during imaging for unrelated conditions. Their management remains controversial due to the limited data available. Here, we report the case of a 72-year-old male who presented with gastrointestinal bleeding and was found to have an incidental 4.9 cm PVA on abdominal computed tomography angiography (CTA), managed conservatively with regular follow-up imaging and monitoring. PVAs, while rare, present a significant clinical challenge due to the lack of consensus on their management. Treatment strategies range from conservative monitoring to surgical intervention, depending on the presence of symptoms, aneurysm size, and underlying etiology. This case highlights the importance of a multidisciplinary approach in managing PVAs, particularly when they are discovered incidentally. Further research is needed to develop standardized guidelines that address the nuances of treating both congenital and acquired PVAs.

Anticoagulant Treatment of a Thrombosed Giant Portal Vein Aneurysm

Teaching point: Anticoagulation is advised in thrombosed portal vein aneurysm (PVA) without portal hypertension.

Portal Vein Aneurysm in a Patient with Cirrhosis Type C Controlled by Direct-Acting Antiviral Treatment

Introduction

Portal vein aneurysm (PVA) is a rare saccular or fusiform portal vein dilatation. The management and optimal treatment of PVA remain unknown.

Case Presentation

A 53-year-old man with hepatitis C virus (HCV) infection was diagnosed with PVA measuring 28 mm in diameter. Under observation, his liver fibrosis progressed, and the PVA diameter gradually increased to 52 mm. The patient was treated with elbasvir-grazoprevir for 12 weeks, and HCV disappeared. After achieving sustained virological response, liver fibrosis improved and the PVA progression ceased.

Conclusion

HCV clearance by direct-acting antiviral treatment not only regressed liver fibrosis but may have also restrained the progression of PVA in a patient with cirrhosis type C and PVA.