Symptomatic Presentation of Intrahepatic Portal Vein Aneurysm

A 52-year-old female without comorbidities presented with dull, aching pain in the right upper quadrant associated with nausea, but not fever, jaundice, anorexia, or abdominal distension. Examination showed tachycardia and mild tenderness in the right upper quadrant. Investigations revealed a normal hemogram with preserved liver function, renal function, and normal pancreatic enzyme levels. Abdominal ultrasound revealed a space-occupying lesion in the right hemiliver. Abdominal magnetic resonance imaging (MRI) revealed a 5.8 x 5.6 x 4.5-cm, well-defined subcapsular lobulated T1hypointense and T2-hyperintense lesion in segment V and VI. During post-contrast MRI, the lesion showed complete filling on venous phase, which persisted in the equilibrium phase, turning iso-intense on delayed hepatobiliary phase. The segment V branch of right portal vein showed “luminal continuity” sign (Figure 1). A Doppler ultrasound of the liver showed anechoic signal from the lesion with color filling on Doppler and monophasic flow on pulsed Doppler, consistent with portal vein aneurysm (PVA; Figure 2).