Detection rate of intrahepatic portohepatic venous shunt in a mass survey

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From 1992 to 2003, the detection rate of intrahepatic portohepatic venous (PV) shunt in a mass survey using abdominal ultrasonography was 26 cases among 179, 242 persons (0.014%); 0.017% in men, 0.010% in women. Beginning in 1998 we adopted ultrasonic diagnostic instruments with a Doppler function. The detection rate of intrahepatic PV shunt increased to 0.02% in this latter period, representing an additional 0.007%. The male: female ratio was 3.3:1, and the mean age was 53.3 years. No subject had abnormal blood tests. Sites of PV shunts were the right hepatic lobe in 17 patients, and the left in 9. When we compared 20 cases detected after 1998 (group B) with 6 detected before 1998 (group A), the mean diameter of the PV shunt in group B was 17.0mm, significantly smaller than in group A (142mm). Nine shunts had been missed in mass surveys; 4 of these cases were misdiagnosed with liver cysts, and 5 lacked apparent findings. Ultrasonic instruments with a color Doppler capacity contributed to improved detection. Careful study of ultrasonographic features of any cystic lesion or dilated portal vein in the liver is needed, including confirmation of a Doppler signal within the abnormality.
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