Non-target lung embolization during portal vein embolization due to an unrecognized portosystemic venous fistula: A case report

Figure 1 Contrast enhanced computed tomography of the liver. A: Axial computed tomography showed multiple hepatic metastasis in right liver lobe; B: Coronal computed tomography showed multiple hepatic metastasis in the right liver lobe and small left hepatic lobe.

Figure 2 Conventional portogram during portal vein embolization procedure. A: Conventional portogram through vascular sheath placed through right portal vein. Early phase showed normal anatomy; B: Delayed image of conventional portogram showed a fistula tract arising from right portal vein (arrow); C: More delayed image of conventional portogram showed a fistula tract draining into the inferior vena cava (arrow); D: Right portal conventional portogram image after vascular plug placement showed portovenous fistula tract; E: X-ray image at the end of the portal vein embolization showed glue-lipiodol hyperdense materials in the right liver lobe and multiple similar densities in both lungs more at left lung in keeping with multiple non target lung embolization.

Figure 3 Contrast enhanced computed tomography of the liver. A: Axial computed tomography (CT) showed post portal vein embolization shrinkage of right liver lobe and hypertrophy of left liver lobe; B: Axial CT showed post-operative hypertrophic left hepatic lobe.