A 35-year-old woman presented with massive haematemesis. Emergency upper gastrointestinal endoscopy revealed oesophageal varices, and endoscopic sclerotherapy was provided. Liver function tests were normal. CT showed massive splenomegaly with grossly dilated and tortuous splenic vein (thin arrow) and attenuated main portal vein (thick arrow) and its intrahepatic branches (figure 1). Mild atrophy of the liver with a smooth outline was noted. These features were highly suggestive of non-cirrhotic portal fibrosis (NCPF). Multiple saccular and fusiform aneurysms were seen, involving the entire splenic artery (arrows) in coronal-reformatted and volume-rendered images (figure 2), the largest measuring approximately 2.5 cm. Splenic artery aneurysms are seen in less than 10% of patients with cirrhosis and portal hypertension and extremely uncommon in NCPF. Increased splenic blood flow secondary to reduced arte-riolar resistance is commonly seen in chronic liver disease, and this in long term has been related to the development of splenic artery aneurysms.
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