title: Portal hypertension induced by congenital hepatic arterioportal fistula: report of four clinical cases and review of the literature.
abstract: Intrahepatic arterioportal fistula (IAPF) can be caused by many secondary factors. We report four cases of portal hypertension that were eventually determined to be caused by congenital hepatic arterioportal fistula. The clinical manifestations included ascites, variceal hemorrhage and hepatic encephalopathy. Computed tomography scans from all of the patients revealed the early enhancement of the portal branches in the hepatic arterial phase. All patients were diagnosed using digital subtraction angiography (DSA). DSA before embolization revealed an arteriovenous fistula with immediate filling of the portal venous radicles. All four patients were treated with interventional embolization. The four patients remained in good condition throughout follow-up and at the time of publication. IAPF is frequently misdiagnosed due to its rarity; therefore, clinicians should consider IAPF as a potential cause of non-cirrhotic portal hypertension.
authors.affiliation: Dan-Ying Zhang, Shu-Qiang Weng, Ling Dong, Department of Gastroenterology of Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Dan-Ying
authors.initials: DY
authors.lastname: Zhang
authors.affiliation: Dan-Ying Zhang, Shu-Qiang Weng, Ling Dong, Department of Gastroenterology of Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Shu-Qiang
authors.initials: SQ
authors.lastname: Weng
authors.affiliation: Dan-Ying Zhang, Shu-Qiang Weng, Ling Dong, Department of Gastroenterology of Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Dong
authors.affiliation: Dan-Ying Zhang, Shu-Qiang Weng, Ling Dong, Department of Gastroenterology of Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Xi-Zhong
authors.initials: XZ
authors.lastname: Shen
authors.affiliation: Dan-Ying Zhang, Shu-Qiang Weng, Ling Dong, Department of Gastroenterology of Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Qu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D010690:Phlebography / Q000379:methods; D017082:Portal Pressure; D011169:Portal Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Ascites; Intrahepatic arterioportal fistula; Portal hypertension