Arteriovenous fistulas between the hepatic artery and portal vein are rare, with only 31 reported since 1950, following the initial description by Sachs' in 1892. Hepaticoportal fistulas are either congenital or acquired. Acquired fistulas occur most commonly secondary to liver tumors, but may be seen secondary to ruptured hepatic artery aneurysms, penetrating wounds, liver biopsies, or abdominal trauma. Seventeen cases of hepaticoportal fistulas have been reported secondary to penetrating wounds, biopsies, or abdominal trauma. This is the first case report in which the ultrasound appearance of this entity is described.
CASE REPORT
A 54-yr-old black male presented to the emergency room with complaints of weight loss, and a history of alcoholism. Physical examination revealed upper abdominal scars and was otherwise unremarkable except for the incidental finding of a midepigastric bruit and a palpable thrill. Admitting laboratory values revealed a normal hematocrit and urine analysis. Liver function tests including SGOT, bilirubin, serum albumin, and prothrombin time were all normal. Alkaline phosphatase determination was slightly elevated at 113 (normal: 20-105 dliter). Pertinent past medical history included stab wounds to the upper abdomen 6 yr prior to admission. At that time exploratory laparotomy revealed a liver laceration secondary to a stab wound which was partially debrided and repaired. A splenic laceration was also discovered which necessitated a splenectomy. The postoperative course was uneventful,