Portal vein aneurysm with complete spontaneous regression after 10 years using conservative treatment
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CASE REPORT
Portal vein aneurysm with complete spontaneous regression after 10 years using conservative treatment Yukihiro Watanabe1 · Kenichiro Takase1 · Katsuya Okada1 · Masayasu Aikawa1 · Kojun Okamoto1 · Isamu Koyama1 Received: 17 February 2020 / Accepted: 13 May 2020 © Japanese Society of Gastroenterology 2020
Abstract Portal vein aneurysms are rare vascular findings for which there are no optimal treatment guidelines. The scarce knowledge about their etiology, natural history, and management mean that there are limited treatment options. Here, we describe the case of a 69-year-old woman who presented with a 35-mm hypoechoic area in the hilar region of the liver that was accidentally detected by ultrasonography. Color Doppler ultrasonography demonstrated a mass with internal flow contiguous with portal vein, which was confirmed to be a portal vein aneurysm by computed tomography. Given that she experienced no symptoms of impending rupture or thrombosed aneurysms, we adopted a conservative treatment. Follow-up imaging demonstrated slow progression of the aneurysm diameter, from 35 to 43 mm at 3 years, and to 48 mm at 6 years; subsequent imaging after 6 years did not show any change in the diameter from 48 mm. However, the portal vein aneurysm completely regressed with no complications at a follow-up of over 10 years. This case suggests that long-term observation with periodic imaging may be an acceptable therapeutic option for asymptomatic portal vein aneurysms that show no short-term improvement. This case report contributes to a better understanding of how to treat this rare disease. Keywords Portal vein aneurysm · Complete regression · Venous aneurysm
Introduction Portal vein aneurysm (PVA) is defined as a saccular or fusiform of portal vein segment that is larger than 2 cm [1]. While previous reports have estimated a PVA incidence of 0.43%, the development of imaging technologies such as magnetic resonance (MR) and computed tomography (CT) has resulted in higher incidence estimations in recent years [2, 3]. PVAs are most commonly classified by their location (intrahepatic or extrahepatic) and etiology (acquired or congenital) [4, 5]. PVAs are most commonly found in the main portal vein and the confluence of the splenic and superior mesenteric veins, which forms an extrahepatic portal vein aneurysm [3, 4]. Most PVAs are acquired and are often associated with liver disease and portal hypertension [6]. Patients with PVAs are at risk of further complications, such as thrombosis, manifestations due to compression against * Yukihiro Watanabe watanb@saitama‑med.ac.jp 1
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Yamane 1397‑1, Hidaka, Saitama 350‑1298, Japan
the common bile duct, duodenum, or inferior vena cava, and spontaneous rupture. Because of the rarity of PVAs, it has been difficult to generate widely accepted management guidelines. The current preferred treatment for asymptomatic and small PVAs is conservative treatment with regular CTs ever
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