Abnormal Intrahepatic Vascular Shunt: rule of high sensitive color doppler and contrast harmonic imaging

ARTEROPORTAL SHUNT (case 2)

Cadence Coherent Contrast Imaging (low mechanical index = 0.2) and SonoVue (Bracco): we can evaluate, in real time, an early enhancement of the hepatic lesion; the arterial and the portal vessels are seen.

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At 42 seconds an overlapping of harmonic information comes from the sinusoidal, arterial and venous vascular bed.
A.D.I. with high mechanical index, allows micro bubbles destruction visualising the arterial and portal major vessels. In the re-perfusion time we can evaluate the enhancement before of the arterial vessel and then of the adjacent portion of portal branch. An intra-lesional fistula can be picked up.
The diagnosis was of high flow haemangioma associated with artery – portal fistula.

[click to see clip]