Very concerned

Can anyone help. It was found that I had a intrahepatic arterioportal shunt on an MRI in December I have waited till the 30th of Jan to see consultant about it. In between that time I had lots of scratching odema a very swollen stomach and terrible mood swings and I'm sad to say that nothing has changed. But what does have me really worried and bewildered is when I seen the consultant he told me I have nothing to worry about and that my bloods for my liver came back normal. I can't quite understand how they find this intrahepatic arterioportal shunt is nothing to worry about PLEASE can anyone help or advise me.

Many thanks

Kitty

12 Replies

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  • Hi Kittyjack, I too have some weird lesion in my liver that was discovered during an abdominal CT-scan for another problem. I am waiting to have a follow-up MRI with a specific type of contrast to see what the 12mm indetermite lesion in the dome of my liver might be. Clearly I'm hoping it's benign as most are, but in researching what it might be I asked about shunts from the biopsy and I hope you will find this helpful. I suspect what your consultant was telling you was that you have a non-tumorous intrahepatic shunt and you need not worry about it since it is likely from either a prior biopsy or intraductal scarring. Might have been a lot more helpful had she/he told you that it was just a bloody scar in the liver instead of causing you further worry. I hope this extract is helpful to relieve your worries:

    ======================================================================

    Intrahepatic arterioportal shunt

    Dr Henry Knipe ◉ and Dr Ahmed Abd Rabou et al.

    Intrahepatic arterioportal shunts represent abnormal flow between the portal venous system and a hepatic arterial system within the liver. They can be a reversible cause of portal hypertension.

    Clinical presentation

    Clinical features will depend on size and other underlying pathology. Small shunts can be asymptomatic.

    Pathology

    Intrahepatic vascular shunts can be divided according to the cause into:

    non tumorous shunt

    mainly due to liver biopsy and other hepatic intervention

    may be due to liver cirrhosis itself owing to deformation of hepatic sinusoids which increases arterial pressure or portal vein extrinsic compression that also lead to increased arterial pressure

    congenital intrahepatic arterioportal fistula (rare) 3

    tumorous shunt

    occurs with hepatocellular carcinoma and to a lesser extent hepatic haemangioma

    trans-tumoural shunt is due to abnormal communication between the feeding artery and draining vein of the tumour which results in increased vascularity around the tumor manifested as peritumoral transient hepatic attenuation differences (THAD)

    portal vein may show early enhancement in dynamic arterial scan without enhancement of its main tributaries the splenic and superior mesenteric veins

    Differential diagnosis

    Sometimes arterio-portal shunt appears in dynamic CT as enhancing nodule, which can mimic hepatocellular carcinoma. The best way to differentiate is by using MRI with SPIO (superparamagnetic iron oxide) which is deposited in hepatocellular carcinoma and washed out in vascular shunt.

    ==================================================================

    My doctor basically told me to not worry because it is very likely a benign hemangioma or a portal shunt from the PBC or a previous biopsy. Please take care and keep in touch. Sometimes I find it helpful just to know that others are here for you. Best,

    Carol--

  • Many many thanks for al the above information Carol pet. I have never had a biopsy the shunt moved itself for some reason and this is what scares me. He never gave me any explanation why or how this happened. My legs look deformed they are that swollen especially the right one. I am still having pain and my stomach still swelling. I just wish I new what it is all about. Again many thanks Carol and good luck.

    Kitty

  • Oh my gosh, Kitty. You should most definitely see another doctor...preferably a gastroenterologist who can review all your records and determine what is causing the edema (oedema in UK) and pain. If need be go to an emergency department and make sure someone pays attention to your symptoms and the fact that you have liver shunting. Please let me know what happens, but please go see someone. I'm not a doctor but your symptoms combined with a disagnosed portal shunt could be serious. Best of luck to you. Carol--

  • HEllon again Carol,it was a gastroenteritis that I seen on the 30th but like I said he gave me no explanation and was only concerned that my bloods for my liver came back normal. On top of that when I seen my GP on Friday 10th she had still not had a report back from him so she couldn't answer any of the questions that I had. I feel I need to know why this has happened as to me it is not normal. I know I have a number of different medical conditions but none of them affecting my liver o now have to wait again for another 2 weeks till I go back to see her on the 24th February. Thank you for your help Carol as it means a lot to me especially when I am left in the dark with so many questions.

    Many thanks

    Kitty x

  • Hi Kitty, Just wanted to let you know I'm thinking of you and hoping the doctor's visit goes well.. I'm off that entire week with my grandson, so I can't check in until I'm back on the 26th, but will be sending good thoughts your way.

    Wanted to say that I quit my first gastroenterologist when he was totally unconcerned about my reaction to the Urso. Switched to a woman who actually had treated PBC (and had another current patient with it) and she has been fantastic. You have the right to someone who treats you with kindness and respect by answering your questions.

    Be sure to write down all the questions you have so you don't forget when you see the doc.

    Warm regards,

    Carol--

  • Many thanks Carol pet I am back to see her this coming Friday 24th. I have wrote a few things down and my head and body need answers so I am definitely going to asked to be referred to another specialist xx

  • How would they be able to tell if it is benign. Probably wouldn't be a good enough answer for me at all. Wouldn't you like them to be CERTAIN? He in case I ever have this.

  • I think generally there are characteristics of benign lesions and those more likely to become malignant. Mine is still indeterminate so it's a matter of watching carefully to see if it changes or my liver functions start to go downhill. The only way to be completely certain is another biopsy and I've just had one 5 months ago so not too keen another this soon. I trust my doctors to be careful and cautious. But I don't TRUST all doctors to that extent.

  • So if your liver enzymes continuously went downhill it would be bad news? That would be enough to determine if the lesion was malignant? Also does anyone know... if taking the urso, should your liver enzymes go back up within normal range? What if you have NAFL disease as well?

  • Also I NEVER WANT another liver biopsy RVER! They're very dangerous too

  • I can't comment on the actual condition, but, in cases like this, always get a second opinion and maybe even third, with other specialists.

    Best of luck and hope you feel better!

  • Many thanks iagra that is what I am going to ask again on the 24th. My GP said she would like to see the report that has not arrived to her yet from the gastroenteritis before she sends me for a second opinion x

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