Purpose or Case Report: Congenital hepatic vascular shunts occur secondary to abnormal formation and aberrant communication of blood vessels during fetal development. This spectrum of anomalies can be challenging to diagnose without a strong understanding of their embryology and clinical and imaging manifestations. Ultrasound is among the most widely used modalities in pediatric imaging, given its real-time nature, easy portability and lack of radiation exposure. This case-based exhibit reviews ultrasound and doppler imaging findings of congenital vascular shunts in the pediatric liver.

The broad categories of congenital hepatic vascular shunts include: arteriovenous (hepatic artery to hepatic vein), arterioportal (hepatic artery to portal vein), and portovenous (portal vein to hepatic vein). This exhibit starts by demonstrating the formation of normal hepatic vasculature during fetal development. This is followed by a discussion of embryological aberrations which lead to vascular shunts, clinical context of each anomaly (when to wait, worry or intervene), and the role of imaging in detection, quantification, prognostication and treatment of these anomalies.

There are case presentations and discussion of the following vascular anomalies: extrahepatic portosystemic shunt (also known as Abernethy Malformation), intrahepatic portosystemic shunt, arterioportal fistula, intrahepatic arteriovenous malformation, patent ductus venosus, infradiaphragmatic total anomalous pulmonary venous return, and hepatic hemangioma. Illustrations and ultrasound/Doppler images are included for most of these cases.

Besides providing a clinical and imaging review of anomalous hepatic vascular communications, this exhibit will reinforce an understanding of physiologic hepatic vascular shunts in fetal life and describe the sequence of successful transition to neonatal circulation. This understanding can be applied to clinical decision making.

Supplemental Files- legends:
1. File 1: Hepatic vascular shunts.
2. File 2: Portosystemic shunt. Turbulent flow within an aberrant vessel connecting left portal to left hepatic vein. Flow pulsatility/triphasicity within the portal vein.
3. File 3: Intrahepatic Arteriovenous Malformation. Tangle of enlarged vessels within left liver lobe. High velocity, low resistance arterial waveforms and pulsatile venous flow.
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