title: Intra-hepatic arterioportal shunt mimicking a metastatic liver tumor: report of a case.
abstract: The differential diagnosis of an arterioportal shunt (APS) is difficult and important. We report a case of an intra-hepatic APS mimicking a metastatic liver tumor on imaging scans in a patient without hepatic cirrhosis. The patient was a 64-year-old woman, who had undergone low anterior resection of the rectum for advanced rectal cancer, followed 2 months later by right hemihepatectomy, including the middle hepatic vein, for a synchronous metastatic liver tumor. About 2 years after the hepatectomy, a follow-up CT scan showed a new mass in the remnant liver, suggestive of a metastatic liver tumor, the assumption of which was further supported by an elevated serum carcinoembryonic antigen (CEA) level. However, the findings of magnetic resonance imaging were not consistent with a malignant tumor, and Doppler ultrasonography showed a low echoic area connected with the portal vein branch and the hepatic artery branch. Thus, we diagnosed intra-hepatic APS. The patient remains well without signs of growth of the hepatic lesion, although with fluctuating serum CEA levels.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan. haruki@jikei.ac.jp
authors.forename: Koichiro
authors.initials: K
authors.lastname: Haruki
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D002272:Carcinoembryonic Antigen / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D012004:Rectal Neoplasms / Q000473:pathology*
chemical_list: D002272:Carcinoembryonic Antigen