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British Journal of Radiology (2005) 78, 265-268
© 2005 British Institute of Radiology
doi: 10.1259/bjr/30325507
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Pseudocyst rupture into the portal vein diagnosed with MRI

A Riddell, MB BS, FRCS, FRCR K Jhaveri, MD and M Haider, MD, FRCP(C)

Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Toronto, M5G 2M9, Canada



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  		Figure 1. This contrast enhanced CT shows low attenuation thrombus within the portal vein (black arrow) and small serpiginous contrast filled collaterals indicative of cavernous transformation.

 


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  		Figure 2. (a) Lack of flow within the portal vein is confirmed on ultrasound, with no flow on the spectral Doppler trace. Colour Doppler signal is seen in the portal collaterals. (b) This grey scale image shows echogenic material within the portal vein (black arrow), which is similar in appearance to that seen in the pseudocyst (white arrow). Sludge is seen layering in the gallbladder.

 


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  		Figure 3. (a) Axial breath hold fast recovery (BHFR) T2 weighted image shows high signal fluid within the left portal vein (white arrow) and also within biliary radicals (white arrow heads). On this sequence flowing blood within a normal portal vein would be of low signal intensity, and thrombus of heterogeneous intermediate signal intensity. The pseudocyst, which is caudal to this image, had the same signal intensity as the portal vein. The patient also has ascites, predominantly surrounding the anterolateral margin of the liver. (b, c) Coronal T1 weighted images show homogeneous low signal intensity within (b) the portal vein (white arrow) and (c) anterior pseudocyst (white arrow), consistent with fluid rather than thrombus.

 


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  		Figure 4. This T2 weighted radial slab image shows high signal fluid within the common bile duct and biliary tree (black arrowheads), the pseudocyst (open black arrow) and the portal vein (black arrow). Signal would not normally be returned from flowing blood within the portal vein.

 


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  		Figure 5. A series of three axial single shot fast spin echo (SSFSE) T2 weighted images show a tract passing from (a) the posterior aspect of the pseudocyst to (c) the main portal vein.

 




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