Presentation
Elevated liver function tests
Patient Data
Age: 60 years
Gender: Male
From the case:
Congestive cardiac failure
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- cirrhotic liver
- dilated inferior vena cava with reflux of contrast through it on arterial phase
- dilated portal and splenic veins with multiple dilated venous collaterals at splenic hilum
- mild splenomegaly
- diffuse gallbladder wall edema
- mild free ascites extending to lesser sac
- diffuse mesenteric fat stranding
- diffuse truncal subcutaneous edema
- diffuse wall thickening of the urinary bladder with left-sided diverticulum
- left inguinal hydrocele
- large varicose veins at right femoral region draining at saphenofemoral junction
Scans through the base of the chest revealed:
- multi-chamber enlargement of the heart with straightening of interventricular septum
- right middle lobe abnormal tangle of blood vessels between dilated subsegmental pulmonary artery and vein, suggestive of pulmonary arteriovenous malformation
- sliding hiatal hernia
Case Discussion
The CT findings on this case are mostly due to congestive heart failure with cardiac-related cirrhosis, right-sided volume overload and development portal hypertension.
Pulmonary arteriovenous malformations can occur in a variety of clinical situations, including liver and cardiac diseases, trauma and systemic disorders. They mostly occur in lower lung zones and subpleural location.
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