Tc-99m RBC blood-pool imaging demonstrates umbilical vein in portosystemic shunt

Dynamic hepatic scintigraphy in a patient with longstanding ethanolism revealed hepatofugal drainage of the liver area. That this pathway represented the umbilical vein was shown by subsequent blood-pool images. The umbilical vein drained the left portal vein into venous channels in or near the anterior abdominal wall. These channels proceeded through epigastric vessels into the right femoral/iliac venous system. The umbilical vein may serve as a shunt from the portal system to the systemic circulation in cases of portal hypertension. Blood-pool imaging has a potential role in clarifying possible venous channels identified by hepatic scintiangiography, and can suggest the presence of portal hypertension when these vessels are visualized.