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 diabetis not control blood sugar. Patient has some subcoma crisii had been treated in many hospitals, now she is somnolence, easy in sleeping after eating..but cannot sleep at night. MRI of the brain, radiologist detected hyperintense T1 at basal ganglion area, susgested hepato-encepalopathy (image MRI).

Checking the liver by blood tests, liver function is still good, but ultrasound of liver detected porta-hepatic vein shunting very high flow ( see US image 1 dilatation cystic intrahepatic, US 2, color Doppler: Shunting porta-hepatic and US video)

MSCT angioof 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-hepatic shunting).

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