Congenital portosystemic shunts (CPSS) are rare anomalies that divert blood flow from the liver to the systemic venous system. This case series reviewed sonographic findings, shunt classification, ultrasound shunt ratios, and outcomes in nine children (5 females, 4 males) treated between 2015 and 2022. The shunts were categorized using the Parks classification and monitored through serial ultrasounds. Type 3 shunts were the most common. Decreasing shunt ratios correlated with lower ammonia levels and eventual spontaneous closure. High shunt ratios and Type 4 shunts were predictors of non-closure. Sonographic shunt ratio calculations may correlate with ammonia levels, indicating hepatic encephalopathy risk and predicting closure timing.
