Transjugular intrahepatic portosystemic shunt (TIPS). This patient with cirrhosis presented with profuse haematemesis due to gastro-oesophageal varices. The round structure in the left upper quadrant on these images represents the gastric balloon of a Sengstaken-Blakemore tube, which was inserted as a temporary measure to control the haemorrhage while a TIPS was being arranged. A TIPS shunt is inserted using a device passed through the (usually right-sided) internal jugular vein. This is advanced into one of the hepatic veins, and ultrasound is then used to help guide the catheter through the liver parenchyma into the portal vein. In the image on the left, a catheter remains visible in the portal vein, and the metal shunt has been deployed. The image on the right has been taken following contrast injection and shows the expected flow of contrast directly from the portal vein, through the shunt and into the hepatic vein.