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2006-04-26-11 Answer to the case of the week 174 © De Crespigny

Answer to the case of the week #174

August 18 - 31, 2006

Lachlan De Crespigny, MD

Department of Obstetrics and Gynecology, Royal Womens" Care Hospital, Carlton, Australia

This is a 33-year-old, primigravida, with a normal first trimester screening. She was referred to our unit at 18 weeks for a routine scan that revealed a intra-abdominal cyst, lateral to fetal stomach. It appeared to be an arterio-venosus malformation with a single feeding vessel from the umbilical vein and a single vessel returning blood to the inferior vena cava just bellow the heart. Low flow could be seen through the arterio-venosus malformation. The ultrasound findings remained unaltered until the last scan at 34 weeks.

The baby born in good conditions at 34 weeks. There was no clinical abnormality.  After delivery an ultrasound examination revealed an abnormal communication between the portal and hepatic veins. The diagnosis was of portosystemic anastomosis type III.   The pediatrician suggested that these are usually asymptomatic and regress without treatment.  However, since a portion of the portal blood can bypass the liver, it can produce a situation analogous to esophageal varices with a risk of hepatic encephalopathy. 
The baby will be watched but at six weeks of age was asymptomatic.



Carmen Gallego, MD, Marý´a Miralles, MD, Carlos Marý´n, MD, Purificacio´n Muyor, MD, Gabino Gonza´lez, MD, Enrique Garcý´a-Hidalgo, MD. Cogenital hepatic shunts. Radiographics 2004;24(3):755-772

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