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Abdomen » Hepatobiliary
Patent paraumbilical shunt
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Author(s) :
Chaitali Shah, FRCR
Presentation A cirrhotic patient presented for surveillance ultrasound after undergoing an interventional procedure to relieve his symptoms.
Caption: Oblique scan of the liver.
Description: The liver shows a coarse echotexture with a nodular surface and poor through transmission of sound. These findings are consistent with changes of cirrhosis. Also noted is ascitic fluid surrounding the liver.
Caption: Oblique image at the inferior part of the liver.
Description:  In a more medial plane, a large anechoic channel is seen coursing from the porta hepatis toward the anterior abdominal wall.
Caption: Oblique scan in the right hypochondrium.
Description: In an oblique plane through the right upper quadrant a shunt tube is identified within the previously seen venous channel. The round structure at the bottom of the image is the distended gallbladder floating in ascitic fluid.
Caption: Color Doppler image of the shunt.
Description: Color Doppler indicates flow within the shunt.
Caption: Transverse color Doppler image of the shunt.
Description: In this transverse image of the shunt there is complete wall to wall filling of color, suggesting that it is patent.
Caption: Spectral Doppler display of the visualized channel.
Description: A venous waveform is recorded from the color- filled anechoic channel.
Differential Diagnosis Patent shunt through the recanalized paraumbilical vein.
Final Diagnosis Patent shunt through the recanalized paraumbilical vein.
Discussion The paraumbilical vein is a venous collateral channel that opens up in patients with cirrhosis and portal hypertension. It is a potential site for porto-systemic anastomosis. The recanalized paraumbilical vein courses in the falciform ligament and joins the superficial veins of the anterior abdominal wall [caput medusae].

This case has been discussed here to demonstrate the placement of a shunt tube in the recanalized paraumbilical vein [which is not very commonly done], in order to reduce the portal hypertension.
Case References

C Morin, M Lafortune, et al. Patent paraumbilical vein: anatomic and hemodynamic variants and their clinical importance.Radiology,1992. Vol 185, 253-256.

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