Active intrahepatic gadolinium extravasation following TIPS

A 31-year-old male patient had a transjugular intrahepatic portal systemic shunt (TIPS) placed for acute Budd-Chiari syndrome secondary to paroxysmal nocturnal hemoglobinuria (PNH). Post-procedure, he was anticoagulated for his underlying paroxysmal nocturnal hemoglobinuria. After 11 days, he complained of upper abdominal pain and underwent magnetic resonance imaging (MRI). On immediate post-gadolinium spoiled-gradient-echo (SGE) images, active extravasation of gadolinium was depicted in one of two intrahepatic hematomas. Progression of layering of high signal gadolinium was shown from early to later phase post-gadolinium images. The active arterial bleeding was confirmed by conventional angiography performed immediately following the magnetic resonance imaging.