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A 54 year old man with Child's C liver cirrhosis
resulting from alcohol abuse presented with pleuritic right upper
quadrant abdominal pain. He did not have ascites or any history of
gastrointestinal bleeding. On examination, his liver was palpable 4 cm
below the costal margin and was lobular and non-tender. Abdominal
ultrasound revealed a mass in the right lobe of the liver (later proved
by biopsy to be a hepatoma) as well as a shunt on Doppler study. Magnetic resonance angiography of the liver (fig 1) revealed a shunt
(S) between the portal vein (PV) and the hepatic vein (HV) which is
seen joining the right atrium (RA) leading to the inferior vena cava
(IVC). On further questioning, the patient admitted being stabbed in
the right upper quadrant 20 years ago. The majority of the
patients with Child's C cirrhosis have complications like ascites or
gastrointestinal bleeding caused by portal hypertension. The
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