Transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome

Figure 2 Representative enhanced computed tomography images from a 76-year-old male patient in the transjugular intrahepatic portosystemic shunting group. A: Enhanced computed tomography (CT) findings (delayed phase) before transjugular intrahepatic portosystemic shunting (TIPS). At the level of the opening of the hepatic vein, the liver parenchyma showed patchy confluent enhancement as well as a high degree of enhancement around the hepatic vein, resulting in a characteristic "clover sign". The lumen of the hepatic vein showed stenosis or was unclear, and the hepatic segment of the inferior vena cava was compressed and thinned; B: Enhanced CT findings (delayed phase) before TIPS. At the level of the left branch of the portal vein, the liver parenchyma exhibited patchy confluent enhancement, and the left lateral lobe and the caudate lobe of the liver were slightly involved. Low-density edema was present around the portal vein, and there was a large amount of perihepatic effusion; C: Enhanced CT findings (delayed phase, at the level of the opening of the hepatic vein) for the same patient 2 years after TIPS. The ascites had subsided, and the signs of uneven enhancement had disappeared; D: Enhanced CT findings (delayed phase, at the level of the portal vein left branch) for the same patient 2 years after TIPS. Atrophy of the liver was present on the shunt side (i.e., right lobe), and compensatory enlargement of the liver was noted on the non-shunt side (i.e., left lobe).