Clinical Presentation

A 51-year-old man presents with obtundation after a transjugular intrahepatic portosystemic shunt (TIPS) procedure.

(A) Transjugular por tal venogram shows a large gastroesophageal varix (arrow). (B) TIPS placed. (C) TIP S reduction by deployment of a constrained covered stent (arrow) within the preexisting TIPS stent (arrowhead).

Differential Diagnosis

• Hepatic encephalopathy after TIPS placement

Essential Facts