49-year-old male with PSC, cirrhosis, ascites. Evaluate biliary and vessel patency. HCC screen. Pre-OLT evaluation. ABDOMEN:LIVER, BILIARY TRACT: Heterogenous enhancement of the liver in the arterial phase. Of note, there is opacification of the right and left portal veins on the arterial phase with nonopacification of the main portal vein/confluence. This finding is concerning for a central arterial to portal venous shunt. There is nonspecific periportal edema. The portal and hepatic veins are patent, however mild attenuation of the central hepatic veins and IVC are noted.No discrete arterially hyperenhancing lesions. No suspicious lesions with washout are identified. No intra or extrahepatic biliary ductal dilatation. Mild central biliary ductal irregularity is suggested, however a dedicated MRCP exam was not performed. Hepatomegaly. Stigmata of portal hypertension including recanalization of the left umbilical vein, mild gastroesophageal varices, and mild upper abdominal ascites. A nonspecific enlarged portocaval lymph node is also noted (series 1003 image 176). Cholelithiasis without evidence for acute cholecystitis.SPLEEN: Spleen is at the upper limits of normal in size measuring 12 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace perihepatic and perisplenic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Arterial phase perfusional variant of uncertain etiology, with diffuse heterogeneous enhancement of liver noted (may be related to underlying chronic liver disease; visualized hepatic vasculature patent). There is opacification of the right and left portal veins on the arterial phase without opacification of the main portal vein confluence, and this finding is suggestive of an arterial-portal venous shunting. In mild periportal edema is also noted. On the delayed postcontrast phase, there is relative normal opacification of the hepatic parenchyma. 2.Hepatomegaly with stigmata of portal hypertension. No suspicious lesions identified.3.No intra or extrahepatic biliary ductal dilatation. Mild central biliary ductal irregularity is suggested, however a dedicated MRCP exam was not performed.