CTICasesSystemic-to-Pulmonary Venous Shunt with Cirrhosis
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Imaging findings
CT in a cirrhotic patient showed large paraesophageal varices and a lobulated vascular structure connecting these varices directly to a dilated pulmonary vein. Multiphasic imaging (HCC protocol) demonstrated differential opacification of the pulmonary veins, highlighting the shunt flow. Coronal reconstructions clearly depicted the connection between the systemic varices and the pulmonary venous system.
Key takeaways
In patients with cirrhosis and portal hypertension, systemic-to-pulmonary venous shunts can develop as a mechanism to decompress the portal system. These shunts involve direct connections between systemic varices (e.g., paraesophageal) and pulmonary veins. They can be large and are well visualized on contrast-enhanced CT, especially with multiphasic protocols that show rapid opacification of the pulmonary vein via the shunt. While not an everyday occurrence, such shunts are a recognized, albeit uncommon, phenomenon in advanced liver disease, and their full clinical significance is still being investigated.
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