CTICasesPortopulmonary Venous Anastomosis (Intrathoracic Varices)
Imaging findings
CT imaging demonstrates cirrhotic changes of the liver with ascites and a large cluster of mediastinal and retroperitoneal varices. Contrast-enhanced CT in the delayed phase clearly demonstrates a cluster of varices within the left lower lobe of the lung that drains directly into a peripheral branch of the left inferior pulmonary vein.
Key takeaways
In patients with severe portal hypertension, portosystemic collateral pathways can rarely extend into the thorax and form direct portopulmonary venous anastomoses. These intrathoracic varices can mimic a pulmonary nodule or vascular malformation on imaging, and recognition of their connection to the pulmonary veins is critical to avoid accidental biopsy or catastrophic hemorrhage.
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