# Obliterative Hepatocavopathy: The “Acrobatic Dolphin” Mimic as Endovascular Procedure Guide

## TL;DR

A unique dolphin-like radiographic pattern helps diagnose and guide treatment for a rare liver vein blockage in underprivileged Asian populations.

## Contribution

Introduces the 'Acrobatic Dolphin' mimic as a novel radiographic sign for diagnosing and treating membranous inferior venacava obstruction.

## Key findings

- The dolphin-like configuration aids in identifying membranous inferior venacava obstruction during venacavography.
- The sign serves as a procedural guide for successful membranotomy in affected patients.
- Recognizing such patterns enhances clinical education and diagnostic accuracy.

## Abstract

Obliterative hepatocavopathy, also known as membranous obstruction of the inferior venacava, is a frequently underdiagnosed vascular condition, seen particularly in low socioeconomic populations in India, Nepal and other parts of Asia. This viewpoint presents a distinctive radiographic analogy- the “Acrobatic Dolphin” mimic-observed during venacavography in a patient with membranous inferior venacava obstruction. The dolphin-like configuration, best appreciated in the left anterior oblique view, featured a conical beak-shaped membrane formed by flow dynamics that served both as a diagnostic clue and as an endovascular procedural guide for successful membranotomy. Moreover, recognition of such radiological signs provides powerful mnemonics that enhance clinical education.