Successful embolization of a large intrahepatic portosystemic shunt using the coil-in-plug technique: A case report assessed with four-dimensional flow magnetic resonance imaging

Congenital intrahepatic portosystemic shunts are uncommon vascular anomalies that can lead to hyperammonemia and liver dysfunction. We report a 48-year-old woman with a large intrahepatic shunt presenting with elevated blood ammonia and progressive hepatic atrophy. She underwent percutaneous coil-in-plug embolization using an Amplatzer Vascular Plug II filled with coils. Four-dimensional Flow MRI performed before the procedure and at 2 days and 6 months afterward demonstrated complete shunt occlusion, restoration of normal portal flow, and increased liver volume. Her ammonia level normalized within 1 day, and the patient remained asymptomatic. This case highlights the safety and efficacy of the coil-in-plug technique for large intrahepatic shunts and underscores the utility of four-dimensional Flow MRI for treatment planning and follow-up.