Clinical presentation:
Indian man with a drinking problem.

The (late) view is from a barium series and shows resting fluid in the fundus, but coating of the mucosa of the body of stomach, where sinusoidal folds are present. The pyloric antrum and small-bowel appear normal. There is a large smooth soft-tissue density in the left hypochondrium that is consistent with massive splenic enlargement.

The view, from a splenoportogram, shows a nice correspondence with the barium image. The portal vein is enlarged and varices are present in the body of stomach, extending towards the cardia. Additional varices nearer the mid-line are probably in or near the falciform ligament. The numerous large intrahepatic portal vein branches end abruptly.

A normal portal vein (with a gall-stone and some intra-peritoneal leak of contrast) is included for comparison.

This examination is now, thankfully, obsolete. The patient is stabbed in the side with a long flexible needle to allow direct injection of contrast into splenic pulp with filling of splenic veins. It runs the obvious risk of splenic laceration. Computed tomography with intravenous contrast and late views (more than 40 seconds) are a better alternative, but the diagnosis can be made more quickly and cheaply with ultrasound.

Note how the lack of mixing (laminar flow?) allows the heavier contrast to fill the right portal veins to a greater extent than the more anterior left portal branches. All views are with the patient supine.