CTICasesPorto-Pulmonary Hypertension with Embolized Esophageal Varices to Inferior Pulmonary Vein
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Imaging findings
Cardiomegaly, distended azygos vein, dilated main pulmonary artery, and enlarged right ventricular chambers, consistent with pulmonary hypertension in the context of chronic liver disease and cirrhosis (porto-pulmonary hypertension). Extensive esophageal varices are noted, with a direct anastomotic connection to an inferior pulmonary vein, causing contrast dilution. A blocker device and coils were deployed to embolize this connection. Associated findings include left basal pleural opacity, atelectasis, pleural fluid, subcutaneous edema, and ascites.
Key takeaways
Patients with chronic liver disease and porto-pulmonary hypertension can develop significant hypoxemia, partly due to large esophageal varices forming direct portosystemic shunts with pulmonary veins. This case demonstrates the embolization of such a varix-to-pulmonary vein shunt, an unusual interventional approach to address the hypoxemia, with careful measures taken to prevent coil migration into the systemic circulation.
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