A 56-year-old woman is admitted because of confusion, tiredness, apraxia and asterbds. Her medical history consists of a complicated cholecystectomy and multiple episodes of 'hepatic' encephalopathy without severe liver disease (liver biopsy showed steatosis without fibrosis).Phlebography of the liver shows patent sushepatic veins and the hepatic venous pressure gradient is 4 mmHg. Arteriography of the hepatic artery is normal. Normal hepatopetal flow in the splenic and portal vein (PV). Injection of the superior mesenteric artery visualizes the presence of a mesocaval shunt (MCS) on the late indirect mesenterico-portal images, which originates at the level of the venous confluens (VC) and drains into the inferior vena cava (IVC) (Fig. 1A). There is no connection with the PV. Visualization of the celiac axis, confirms the MCS, originating at the level of the VC of PV and lienalis vein (Fig. IB). Magnetic resonance imaging, shows slices through the MCS and a connection with the superior mesenteric vein (Fig. 1C).
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