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+We report the case of a 68-year-old female with no past medical history, presented with an upper gastrointestinal bleeding and pain in left upper abdomen.
+Physical examination found a splenomegaly and signs of portosystemic collateral formation including abdominal wall dilated veins and rectal haemorrhoids.
+No biological abnormalities were noted besides those due to hypersplenism (anaemia and thrombocytopenia).
+The patient underwent upper gastrointestinal endoscopy that showed stage III oesophageal varices with portal hypertensive gastropathy and red signs.
+Ultrasonography revealed a fusiform dilatation of the portal bifurcation measuring 40 mm in diameter with dilated branches; no signs of portal thrombosis were detected (Figure 1).
+The portal Doppler study showed a normal hepatopetal flow.
+Other signs of portal hypertension were found, including splenomegaly, repermeation of the umbilical vein and a splenorenal collateral circulation.
+A complementary angio-CT allowed a better assessment of the portal system that contained some thin calcifications in the aneurysmal wall and the main portal trunk (Figure 2, Figure 3, Figure 4).
+Other signs of portal hypertension were noted such as oesophageal and gastric varices, parietal collateral circulation associated to ultrasonography findings.
+Liver cirrhosis was confirmed by transcient elastometry and biopsy.