title: Spleno-parametrial ectopic varices: an unusual porto-systemic shunt in portal hypertension.
abstract: BACKGROUND
  Cirrhotic liver disease commonly is complicated by portal hypertension, and the resultant porto-systemic shunts are an important cause of morbidity and mortality in cirrhotic patients. Identification of these shunts and their management is an important part of the medical care provided to this population.
  
  
  METHODS
  We present the case of a patient with nonalcoholic steatohepatitis or nonalcoholic fatty liver disease and resultant portal hypertension who developed an unusual porto-systemic shunt, which at first was thought to represent a highly vascular gynecologic mass. The splanchnic blood was shunted through a recanalized vein interconnecting the splenic vein with the parametrial venous plexus.
  
  
  CONCLUSIONS
  Unrecognized portal hypertension and resultant porto-systemic shunts may mask themselves as vascular masses and result in catastrophic surgical outcomes if not fully characterized preoperatively.
authors.affiliation: From Fletcher Allen Health Care, University of Vermont, Departments of Radiology and Obstetrics, Gynecology and Reproductive Sciences, Burlington, Vermont.
authors.forename: Dmitriy G
authors.initials: DG
authors.lastname: Akselrod
authors.forename: Cheung
authors.initials: C
authors.lastname: Wong
authors.forename: David P
authors.initials: DP
authors.lastname: Keating
mesh_terms: D000290:Adnexa Uteri / Q000098:blood supply*; D000328:Adult; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000209:etiology; D065626:Non-alcoholic Fatty Liver Disease; D011859:Radiography; D013154:Spleen / Q000098:blood supply*; D014463:Ultrasonography; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000209:etiology