IMAGES IN IR
Portal–Left Atrium Shunt Leading to Stroke Umberto G. Rossi, MD, Giovanni Gandini, MD, and Maurizio Cariati, MD
Figure.
From the Department of Diagnostic Sciences, Division of Radiology and Interventional Radiology (U.G.R., M.C.), San Carlo Borromeo Hospital, Via Pio II, 3, 20153 Milano, Italy; and Department of Radiology and Interventional Radiology (G.G.), Città della Salute e della Scienza di Torino Hospital, Torino, Italy; E-mail: [email protected] None of the authors have identified a conflict of interest. & SIR, 2014 J Vasc Interv Radiol 2014; 25:363 http://dx.doi.org/10.1016/j.jvir.2013.11.019
A 37-year-old man presented acutely with a stroke, ataxia, and left upper limb weakness. His medical history was positive for congenital low-grade liver fibrosis and for a single episode of paresthesia of the left upper limb (4 y previously). Magnetic resonance imaging showed acute ischemic lesions in the right cerebellum and temporal region (Fig a). Chest radiography, blood tests, and echocardiography were normal. Computed tomography demonstrated dilatation of the portal vein and gastroesophageal varix arising from the left gastric vein (arrowhead) and reaching the left atrium (arrow), which is partially contrasted in the venous phase and totally contrasted in the delayed phase (Figs b–d). The diagnosis of embolic stroke secondary to portalsystemic shunt was made. He underwent left cardiac atrium transseptal catheterization with percutaneous embolization of the portal–left atrium shunt. Followup examination at 18 months demonstrated resolution of neurologic symptoms.
Portal–Left Atrium Shunt Leading to Stroke Umberto G. Rossi, MD, Giovanni Gandini, MD, and Maurizio Cariati, MD
Figure.
From the Department of Diagnostic Sciences, Division of Radiology and Interventional Radiology (U.G.R., M.C.), San Carlo Borromeo Hospital, Via Pio II, 3, 20153 Milano, Italy; and Department of Radiology and Interventional Radiology (G.G.), Città della Salute e della Scienza di Torino Hospital, Torino, Italy; E-mail: [email protected] None of the authors have identified a conflict of interest. & SIR, 2014 J Vasc Interv Radiol 2014; 25:363 http://dx.doi.org/10.1016/j.jvir.2013.11.019
A 37-year-old man presented acutely with a stroke, ataxia, and left upper limb weakness. His medical history was positive for congenital low-grade liver fibrosis and for a single episode of paresthesia of the left upper limb (4 y previously). Magnetic resonance imaging showed acute ischemic lesions in the right cerebellum and temporal region (Fig a). Chest radiography, blood tests, and echocardiography were normal. Computed tomography demonstrated dilatation of the portal vein and gastroesophageal varix arising from the left gastric vein (arrowhead) and reaching the left atrium (arrow), which is partially contrasted in the venous phase and totally contrasted in the delayed phase (Figs b–d). The diagnosis of embolic stroke secondary to portalsystemic shunt was made. He underwent left cardiac atrium transseptal catheterization with percutaneous embolization of the portal–left atrium shunt. Followup examination at 18 months demonstrated resolution of neurologic symptoms.
