Fig. 5. A 15-year-old female patient presenting with abdominal pain and ascites. Model for end-stage liver disease (MELD) score of 10 and Rotterdam score of 1.1 (Class 1). The hepatic venogram showed stenosis involving distal middle hepatic vein (arrows; A, B). Right hepatic vein and left hepatic vein were occluded. Inferior venecava (IVC) was patent. Through transhepatic approach, multiple attempts were made to cross the occlusion. The guide wire punctured the hepatic vein and entered the right atrium directly (arrow; C) without entering the IVC, which was missed initially. Angioplasty (arrow; D) resulted in massive pericardial tamponade (arrow; E). Despite performing emergency thoracotomy and repair of the tear in the myocardium the patient could not be saved.
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