Spontaneous Intrahepatic Portal Systemic Venous Shunt: It Can Happen!

A 73-year-old man with a past history of hepatitis C virus infection presented with altered mental status. The patient had multiple previous similar admissions in the past year. It was presumed that the patient had underlying cirrhosis because of a low platelet count. Physical examination did not show any ascites or stigmata of chronic liver disease. A computed tomography scan of the abdomen and pelvis was performed that showed a tortuous venous structure in the left lobe of the liver consistent with a spontaneous intrahepatic portal systemic shunt (Figures A and B).

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