Presentation
Known chronic liver disease patient now presenting with acute abdominal pain.
Patient Data
Prominent bilateral breast glandularity - gynecomastia.
Morphological features of cirrhosis - surface contour nodularity, volume redistribution (left lobe/caudate lobe hypertrophy, decreased right lobe volume). No focal parenchymal lesions. No IHBRD. The hepatic veins are patent and normally enhancing.
Main portal vein is dilated 14.5mm. It's branches are patent. The splenic vein is dilated (10.3mm). Spleen is enlarged spanning 20cm.
Non opacification of main trunk of superior mesenteric vein up to the portosplenic confluence with perivascular fat stranding. The corresponding jejunoileal loops and proximal third of colon show submucosal edema and mural stratification. Normal mural enhancement pattern. No features of pneumatosis. Larger collateral dilated channels seen in the other tributaries of SMV one of them draining directly into the SMV portal confluence. The IMV and its branches are patent.
Multiple portosystemic collaterals seen - bulk of it splenorenal; recanalized paraumbilical vein and dilated mesenteric vessels.
Superior mesenteric artery and its branches are patent.
The gall bladder is distended with diffuse mural edema and mild pericholecystic fluid. No calculi.
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