Portal vein aneurysm, a pathological entity or an innocent bystander? A review of six cases

Portal venous aneurysms (PVAs) are a rare venous aneurysms. The mean diameter of a healthy portal vein varies considerably, with maximum diameter of 15 mm in healthy subjects and 19 mm in cirrhotic patients. The presentation varies; they could come with abdominal pain or more often as an incident imaging finding. Although risk factors like portal hypertension and liver cirrhosis have been highlighted, the aetiology remains to be clarified. PVA may be associated with various complications: thrombosis, aneurysmal rupture, inferior vena cava obstruction or duodenal compression. A conservative treatment showed satisfying clinical and radiological response, however, surgical and endovascular options can be considered. The aetiology and the mechanism of formation of PVA remain ill-defined. We aimed to use the small cohort of cases to define the distribution and radiological features of PVA and not for determining its prevalence or details of management. We retrospectively reviewed six cases from our institution (King Faisal Specialist Hospital and Research Centre, Jeddah) with variable presentations, complications and outcomes. Our review revealed that portal venous system aneurysms were mostly incidental, single, not gender- or age-specific and were frequently (66%) intrahepatic. Main portal vein was involved in three cases and splenic vein in only one case. Most of the portal venous system aneurysms were fusiform in configuration. Although PVAs are rare, more cases are detected through imaging. Hepatobiliary surgeons, gastroenterologists and radiologists should be aware of this entity, as it can have a wide variety of clinical spectrum. Our review and the limited evidence in published literature suggest that an individualised multidisciplinary team approach should be adopted to decide the best management and outcomes for each patient.