Portal vein embolization for closure of marked arterioportal shunt of hepatocellular carcinoma to enable radioembolization: A case report

Figure 1 A 58-year-old man with hepatocellular carcinoma and marked arterioportal shunt due to portal vein tumor thrombus. A: Axial magnetic resonance imaging T1 post contrast weighted image showing a large hypervascular mass in the right hepatic lobe (white arrows). Note enhancement of the portal vein (orange arrow) in the arterial phase denoting an underlying arterioportal shunt; B: Digital subtraction angiography showing opacified portal vein (white arrows) during the early arterial phase.

Figure 2 Direct portography and hepatic arteriography after portal vein embolization. A: Direct portography revealed carcinoma thrombus formed in the main portal vein (white arrow), and collateral circulation formed with spongy degeneration (orange arrows); B: Hepatic arteriography after portal vein embolization demonstrates non-visualized arterioportal shunt.

Figure 3 Planar scintigraphy following injection of 4. 5 mCi of technetium-99m macroaggregated albumin into the right hepatic artery after using portal vein embolization to embolize the outlet of the arterioportal shunt. The calculated hepatopulmonary shunt was 8.4%.