Development of intrahepatic arterial shunts in a transplanted liver: A potential pitfall for Doppler sonography

We describe the hemodynamic features and anatomic basis of false-negative D oppler sonographic findings compared with angiographic findings in a 42-yea r-old woman after orthotopic liver transplantation complicated by hepatic a rtery thrombosis. Complete common hepatic artery thrombosis was demonstrate d by Doppler sonography and digital subtraction angiography (DSA) on the fi rst postoperative day. A thrombectomy was performed. DSA on the third day a fter transplantation again showed occlusion of the left hepatic artery. No perfusion was observed in the left hepatic lobe. Liver function remained no rmal. Doppler sonography on days 8, 10, and 16 after transplantation demons trated arterial blood flow in both the right and left lobes of the liver, s uggesting patent left and right hepatic arteries. Repeat DSA revealed that the arterial flow in the left lobe depended on large, intrahepatic shunts o riginating from the right hepatic artery. Apparently, shunts can develop wi thin a few days in a transplanted liver from radiologically undetectable st ructures into vessel-like channels capable of supplying the entire left hep atic lobe. (C) 2001 John Wiley & Sons, Inc.