Congenital Portosystemic Shunt

An 86 years old woman with no past history presented for right hypochondrium pain. Abdominal examination was normal. Hepatic test were normal was well as prothrombin time and platelets count. However, hemoglobin level was low at 10.6 g/dL with low ferritin level. Upper endoscopy, colonoscopy and gynecological examination were also normal. Abdominal ultrasound was normal but the liver was difficult to examine due to under costal seat. Hepatic magnetic resonance imaging revealed a congenital portosystemic shunt between the median hepatic vein and the left portal vein (Figure 1). As the shunt was asymptomatic (no encephalopathy, no underlying liver disease) the abstention and surveillance were decided.