Female 64 years old Reason: is there a portosystemic shunt? We are especially concerned for left gastric artery shunt History: Acute worsening Hepatic encephalopathy in patient with cirrhosis on adequate treatment. The study is significantly limited by artifact related to motion and intra-abdominal ascites. Consideration could be given to the fluid tap prior to additional MR imaging.ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates cirrhotic morphology. The gallbladder is nondistended and there is gallbladder wall thickening, likely secondary to diffuse ascites. Questionable tiny gallstones, difficult to evaluate given the wall thickening and underdistention. No suspicious liver lesion. Apparent low signal focus within the left hepatic lobe is felt to represent pulsation artifact from the abdominal aorta. The liver demonstrates diffusely T2 hypointense signal and loses signal on in phase images consistent with iron deposition.Due to suboptimal timing of the contrast bolus the celiac and superior mesenteric artery branches are poorly visualized. The intrahepatic IVC is compressed and the hepatic veins are poorly visualized.SPLEEN: Splenomegaly measuring 14.2 cm, slightly reduced compared to prior study. The spleen loses signal on in phase images consistent with iron deposition.PANCREAS: The pancreas loses signal on in phase images consistent with iron deposition.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent upper abdominal and retroperitoneal lymph nodes which can be seen in the setting of cirrhosis.BOWEL, MESENTERY: Diffuse bowel wall thickening, likely secondary to diffuse ascites.BONES, SOFT TISSUES: No significant abnormality noted.Other: Stable moderate to large abdominal ascites. Again seen is left, right and main portal vein dilatation, recanalized umbilical vein and paraesophageal, gastroesophageal, ventral abdominal and splenic varices.
1.Cirrhotic liver morphology. No suspicious liver lesion.2.Signal loss within the liver, spleen and pancreas on in phase images consistent with iron deposition.3.Stable moderate to large abdominal ascites with multiple collateral vessels as detailed above.4.Visualization of the arteries is poor due to the limitations described above, in particular suboptimal timing of the contrast bolus and the left gastric artery (for which there was clinical concern) is not well seen.