Ultrasound investigation of the abdomen identified a mildly inhomogeneous echo texture of the liver and a solid mass in mid pole of the left kidney consistent with a previously known renal oncocytoma. The gallbladder, common bile duct, pancreas, spleen and great vessels were normal. Mesenteric duplex ultrasound demonstrated markedly elevated flow within the celiac axis at slightly less than 4 L/min. Hepatic artery flow was abnormal, but difficult to accurately quantify. There was normal flow in the superior mesenteric artery (SMA) and in the right main and left portal veins.
A mesenteric angiogram was performed from a right retrograde femoral access initially using a flush catheter for an aor-togram, and then a 5 French SOS-Omni catheter for selective exams of the celiac, splenic, common hepatic, proper hepatic, gastroduodenal, superior mesenteric and inferior mesenteric arteries. Injection of the SMA showed a small duodenal AVM. Injection of the common hepatic artery showed patchy opacification of all of the hepatic parenchyma, produced by diffuse small telangiectasias with evidence of arterioportal shunting (Figure 1). In addition, there were pancreatic telangiectasias with shunting, and the celiac trunk (Figure 2), common hepatic and splenic arteries were all dilated.
Figure 1) Selective celiac arteriogram shows dilation of main branches. Patchy ill-defined opacities throughout the liver are typical telangiectasias
Figure 2) Abdominal aortogram shows dilation of the aorta to the level of the celiac trunk (secondary to high flow through celiac territory). The celiac trunk and its branches are all massively dilated You will always be given and will enjoy paying less money.