Hello,
Thanks for posting your query at DoctorSpring.com
I am Dr.R.K. and I am pleased to assist you.
I went through your case report.
Portal vein aneurysm is a very rare entity and it is most often diagnosed during scanning for some other issues and not due to any specific symptoms it can cause. Thus this entity most often remains without causing any symptoms.
Portal vein is a blood vessel carrying blood to the liver. An aneurysm of portal vein is diagnosed when its diameter is more than 20 mm. In your case it is just 20 mm which indicates that it is in the borderline or in other words a very small aneurysm. There are reports wherein individuals have had 6 cm diameter of the portal vein without any symptoms. So you need not worry about your small aneurysm.
Follow up is needed to see whether it is developing any complications. It may get blocked by a clot or it may get ruptured when the pressure is high as in portal hypertension or it can become too big and cause pressure on the adjacent structures. You have none of these issues. All you need is a regular follow up.
You can have a scan every year or if you develop symptoms like severe abdominal pain or jaundice.
The other issues that you have like the polycystic kidneys and liver and hypothyroidism may not have any effect on this aneurysm.
I hope that answers your question.
Let me know if I can assist you further.
Regards,
Dr.R.K.
Patient replied :
Dr. R. K, Is there any thing you can tell me regarding lifestyle and / or any other habits that could increase the size of the aneurysm and conversely if is anything I could or should be doing to modify the impact or reduce the impact of the aneurysm expanding in size and growing in to a more critical condition???? Any food's, exercise, stress conditions that perhaps would cause continued weakening of the portal vein. Is there any remedy or surgical procedure that would be performed if the aneurysm increases in size over a short period of time??? Thank you so much for your comments. Best, PY
Hello,
If the weakening is since birth or due to some genetic disorder involving blood vessels, there is no nothing you can do about preventing further weakening and all you need is periodic follow up.
You need avoid trauma to the abdomen, pancreatitis and liver disease. The most common cause of pancreatitis and liver disease is alcohol intake. So you need to avoid taking alcohol.
It is unlikely that it would increase in size in a short period of time. Only if there are complications like clot inside, rupture, intervention is needed and the choice depends on the type of complication.
Regards.
Patient replied :
Hello Dr. R.K.,
For monitoring purposes of the aneurysm, you mentioned (in your first response) that a scan once per year should be appropriate. Is a cat scan the only method of accurately measuring / monitoring the size and the location of the aneurysm? Is a sonogram a usual monitoring tool?? It would be much less expensive, yes / no?? If the aneurysm begins to expand in size for whatever reason, is there a surgical procedure that can be implemented to fortify the weakened area?? My father had a large aneurysm on his aorta that was discovered when he was 68 years old. He needed immediate surgery and was under the knife for nearly 8 hours and lost a lot blood. The attending surgical team secured teflon webing around the weakened area. The procedure was a success and my Father ended up living a normal life for seveal more years. According to my Nephrologist my polycystic kidneys and cystic liver conditions are closely connect and congenital. He feels my conditon is stable and my kidney and liver function levels are just a bit below normal (5 -10%) for a man of my age. There my final question is as follows: Is there a time when or a size criteria for the aneurysm when preventitive surgery main be the most appropriate treatment plan????? Thank you for your detailed responses to my questions and concerns.
Best, Philip York
Hi Philip York,
Thanks for getting back to me with more questions.
For monitoring purpose, you can have a ultrasonongraphy with Doppler. This would be much less expensive than a CAT scan. But if USG/Doppler does not provide adequate details then a CAT scan has to be done.
The surgical treatment depends on whether there is portal hypertension or not. If there is portal hypertension, then shunt surgery is done (portocaval or mesocaval shunts). If there is no portal hypertension, then aneurysmography is done. In this procedure, the weakened part is resected and the remaining parts resutured to restore continuity.
If a clot develops inside which extends to the other blood vessels, then a thrombectomy is done.
There is no specific time or size criteria for preventive surgery. If there is associated portal hypertension, immediate shunt surgery is done. If there is no portal hypertension, periodic follow up is all that is needed and intervention done when complications like blood clot or compression of the adjacent structures develop.
Regards.
Patient replied :
Would the recent Cat scan that was done three weeks ago show whether or not portal hypertension is present???? How is that conditon determined, simply by the presence of an aneurysm??? A disc of the Cat scan is being sent to me and I should have it within the next 3 or 4 days. The issue of portal hypertension as a significant trigger for surgery or other preventative or healing treatments was never discussed with me. I'm concerned about this and would appreciate your recommendation, on how I should proceed... To determine and clarify what physically ramifications I'm likely to experience given all the present, from a medical / diagnostic perspective with this type of aneurysm present in my body. I'm also concerned and would like to know whether or not my other pre-existing conditons are making me more acutely prone to portal hypertension or not?????? I don't drink alcohol, I'm very active and have a slender build and for the most part lots of energy. Your response will be greatly appreciated. I would be happy to send you a copy of the actual Cat scan for your review.
Best, Philip York
Hi Philip York,
No need to worry.
If there is portal hypertension, there would be enlargement of the spleen and development of collateral blood vessels and these would be seen in a CAT scan. Since there was no mention about these in your scan report it is unlikely that you have portal hypertension.
Liver disease and blood clot inside the portal vein can cause portal hypertension. You do not have any of these. So it is less likely that you may develop portal hypertension. It is good that you do not drink alcohol as alcohol intake is one of the common causes of liver disease causing portal hypertension. Viral infections like Hepatitis B and C also cause chronic liver disease and portal hypertension. I presume you do not have any of these.
Regards.