Portosystemic Encephalopathy without Liver Disease Masquerading as Dementia

An 84-year-old woman was hospitalized due to consciousness disorder as hyperammonemia. She had no etiology of liver disease. Twelve months before the current admission, she had been diagnosed with dementia based on her low level of daily perception and physical activity. Abdominal computed tomography revealed a large portosystemic shunt between the medial branch of the portal vein and middle hepatic vein. After the improvement of her consciousness disturbance by medical treatment, percutaneous shunt embolization was electively performed. The patient showed a remarkable clinical improvement. Consciousness disturbance caused by hyper-ammonemia might be underlying in dementia patients. Increase of hepatopetal portal blood flow might have contributed to the improvement of her consciousness disturbance. Embolization of the portosystemic shunt might be more effective for patients without liver disease as in the present case

Familial Occurrence of a Congenital Portosystemic Shunt of the Portal Vein

A congenital portosystemic shunt of the portal vein is a very rare vascular anomaly associated with the liver. We report the case of a 5-year-old girl with a patent ductus venosus and her 31-year-old mother with a congenital portosystemic shunt. The child presented with a history of an extremely low birth weight in addition to an atrial septal defect and a patent ductus venosus. At the age of 2, she underwent ligation of the ductus venosus. Her mother was also diagnosed with a congenital vascular anomaly at the age of 16. We have followed up and evaluated her asymptomatic mother for 15 years. To our knowledge, this is the first report describing the occurrence of a congenital portosystemic shunt in both a mother and her child

Skeletal Metastasis in Renal Cell Carcinoma: Photon Deficiency on Bone Scintigraphy

Bone scintigraphy with 99mTc-labeled phosphorous compound is an excellent technique for the detection of bone metastasis. Bone metastases are usually visualized as multiple hot spots on bone scintigraphy. However, photon deficiency in the metastatic lesion on bone scintigrams is reported in few cases with malignancy. In this study, we have evaluated the photopenic bone metastasis from renal cell carcinoma by the radiographic and computed tomographic examinations. Photon deficient metastatic lesions were seen on bone scintigraphy in 5 patients with renal cell carcinoma. All of the photon deficient lesions were osteolytic on bone radiography and computed tomography. The pure photon deficient lesions not associated with surrounding hot margins were seen on the thoracic vertebrae and rib and the ones with surrounding hot margins were seen on the sternum, pelvis and femur. This difference may be due to the differences in the growth rate of the tumor and reactive hyperemia and new bone formation in the metastatic lesions