CASE 315 SPONTANEOUS PORTO-SYSTEMIC SHUNT, Dr PHAN THANH HAI, Dr NGUYEN THI ANH HONG, Dr LE THONG NHAT, Dr TRAN LAM 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 somnolent, easy in sleeping after eating.but cannot sleep at night. MRI of the brain, radiologist detected hyperintense T1 at basal ganglion area, suggested hepato-encepalopathy (image MRI).

Checking the liver by blood tests, liver function is still good, but ultrasound of liver detected porta-systemic vein shunting in 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-hepatic anastomosis like

snake. In 3D CT reconstruction confirmed a high flow porta-systemic shunting).

Bood test reports at this time no ceton , high NH3 = 88,89 mmol/mL (normal 18-72) Conclusion: It is a high flow spontaneous porta-systemic shunting appeared as hepatic encephalopathy in clinical examination.