Azygos continuation of the inferior vena cava (ACIVC) is a rare congenital anomaly characterized by the absence of the intrahepatic segment of the inferior vena cava. Although typically benign and incidental, it can mimic other pathologies on imaging. We present a case of ACIVC in a 37-year-old man, initially misdiagnosed as portal hypertension with mediastinal varices and possible liver cirrhosis, with the diagnosis ultimately confirmed by CT angiography demonstrating ACIVC. This report highlights the diagnostic challenges of ACIVC and underscores the importance of correlating imaging findings with the clinical picture for accurate diagnosis.

Background: Chronic hepatitis D virus (HDV) continues to be a global health concern, and the infection remains challenging to treat. Over the past few decades, pegylated interferons, typically in combination with therapy for hepatitis B, have become the standard of care, with considerable side effects and frequently unsatisfactory results. Several new therapies are emerging, including bulevirtide and lonafarnib. We conducted a systematic review and network meta‐analysis (NMA) to compare the efficacy of bulevirtide, interferons, and nucleos(t)ide analogs, alone or in combination, for the treatment of chronic hepatitis D. Methods: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials and nonrandomized interventional studies assessing HDV RNA suppression, biochemical response, combined response, and histological improvement with various therapies. NMA was performed using a frequentist random‐effects model. Odds ratios (OR) with 95% confidence intervals (CI) were calculated and forest plots were generated. Results: Thirteen studies ( n = 922) were included, studying nine possible treatment arms. At the end of treatment, 31.8% achieved a virological response. Bulevirtide monotherapy (OR 38.63, p < 0.05) and combinations with NA (OR 69.36, p < 0.05) and peginterferon alpha (OR 260.08, p < 0.05) significantly suppressed HDV RNA, with the bulevirtide–peginterferon alpha combination having the highest HDV RNA suppression. At ≥ 24‐week follow‐up, no regimen maintained significant HDV RNA suppression. Biochemical response was achieved in 42.7% at the end of treatment; however, no group reached statistical significance versus control, though bulevirtide and its combination with peginterferon alpha outperformed peginterferon alpha alone. Combined response was highest with bulevirtide–peginterferon alpha (OR 112.69, p < 0.05), followed by bulevirtide monotherapy. Histological response (five studies, n = 183) was not statistically significant with any intervention compared with control. Conclusion: Bulevirtide and peginterferon alpha combination therapy may offer the most promising treatment for chronic hepatitis D. More studies are needed to assess the efficacy of this regimen and establish the optimum dose and duration of treatment.

Percutaneous endoscopic gastrostomy (PEG) is commonly used for long-term enteral access in patients with dysphagia. We report a 67-year-old man with laryngeal carcinoma, prior stroke, and severe dysphagia who developed delayed hemorrhage from a branch of the splenic artery 7 days after PEG placement. He presented with abdominal pain, bleeding through the PEG tube, profound anemia, and hemodynamic instability. Imaging showed hemorrhage in the lesser sac, and angiography confirmed active splenic artery branch bleeding. Endovascular embolization achieved hemostasis. This rare complication is notable for its delayed presentation and favorable outcome after prompt intervention.

Primary Biliary Cholangitis (PBC) is a chronic, immune-mediated cholestatic liver disease characterized by progressive intrahepatic bile duct destruction, leading to pruritus, fatigue, cirrhosis, and eventually hepatocellular carcinoma. Early diagnosis has improved with the development of sensitive serologic assays (e.g., antimitochondrial antibodies, antinuclear antibodies) and the introduction of newer biomarkers. Risk stratification has become standardized with the help of GLOBE and UK-PBC scores, alongside non-invasive tools such as vibration-controlled transient elastography, enabling earlier intervention. Ursodeoxycholic acid (UDCA) is the first-line therapy; however, 30–40% of patients show an incomplete response, increasing their risk of liver failure and mortality. Second-line therapies have emerged which provide viable treatment avenues for those who do not respond to UDCA or are unable to tolerate it. However, in certain situations, such as decompensated cirrhosis, carcinoma, or refractory pruritus, liver transplantation constitutes the only curative therapy. While PBC has excellent post-liver transplant (post-LT) outcomes, patients with PBC face higher waitlist mortality as they tend to have lower MELD scores. Management post-LT includes the use of UDCA, immunosuppressants, and surveillance for recurrent PBC. Our review highlights the recent advances in medical management and transplant risk stratification of patients at risk of decompensation, as well as the perioperative transplant period outcomes and long-term post-transplant management strategies in patients with PBC.