Figure 4a. Thrombosed and sclerosed PV with spontaneous splenorenal shunt. (a) Transverse enhanced CT scan obtained through the porta hepatis. No patent lumen of the PV is identified. (b) Transverse enhanced CT scan shows thrombus (solid arrow) at the portal confluence. A spontaneous splenorenal shunt is evident, with enlarged perisplenic varices (open arrow), an enlarged left renal vein (not shown), and a dilated inferior vena cava (IVC). An interposition venous graft was required.