The first image demonstrates a short dorsally directed vessel evidenced in color flow Doppler (Blue=away from transducer) deriving from the portal vein (splenic vein connection to the portal vein) indicating an extrahepatic shunt likely of splenic vein origin given the short length and position immediately dorsal to the portal vein. The dorsally directed contour would suggest termination either in the vena cava or the azygos vein. The second image of the portal hilus demonstrates the portal vein pre-shunt and post-shunt differential diameter; key to demonstrating the presence of a portosystemic shunt. Note the shunt diameter is 0.95 cm, pre-shunt portal vein 0.53 cm and post-shunt residual portal vein is 0.34 cm in diameter confirming the shunting of blood away from hepatic circulation. The short arrow demonstrates the well defined echogenic line of the diaphragm. The connection of the shunt (color flow Doppler blue) is beyond the diaphragm indicating an azygos vein connection (color flow Doppler red) indicated by the long arrow. Video 1 reveals a 1:1 ratio between the vena cava (near field) and aorta (far field) which is normal. hence the extrahepatic shunt must enter through the diaphragm and into the azygos vein in blue positioned in a vertical dorsally directed manner (Video 2, images 3, 4, and 5)