[Congenital intrahepatic arterio-portal fistula: diagnostic and therapeutic aspects].
The authors report the case of a 4 month old child presenting with a congenital arteriovenous fistula of the left hepatic lobe, revealed by a melaena. Doppler ultrasonography and angiography showed a voluminous vascular malformation fed by a left hepatic artery and fistulized in the portal vein. The therapeutical approach was first palliative, by ligature of the left hepatic artery which proved unsuccessful and resulted in re-permeation of the malformation through a right hepatic artery. Two embolization procedures were then attempted, without success. A left hepatectomy was then performed to remove the malformation. The main event of outcome was the secondary occurrence of a portal cavernoma, with persistent splenic segmentary portal hypertension, and oesophageal varicosity. This case report is the occasion for a literature review on congenital arteriovenous fistulae in the portal region, and for a discussion on therapeutical modalities.
Département d'imagerie médicale, hôpital Pontchaillou, CHRU Rennes, France.
C
C
Meunier
A
A
Dabadie
P
P
Darnault
B
B
Frémond
F
F
Brunelle
J M
JM
Duval
M
M
Carsin
C
C
Treguier
M
M
Roussey
B
B
Le Marec
D001164:Arteriovenous Fistula / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D004621:Embolization, Therapeutic; D006498:Hepatectomy / Q000009:adverse effects; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging; D011859:Radiography; D014463:Ultrasonography