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Hepatic artery thrombosis after liver transplantation is a devastating event requiring emergency retransplantation in most patients. Early clinical signs are often nonspecific. Before duplex sonography (combined real-time and pulsed Doppler) capability was acquired in October 1984, 76% of all transplants in this institution referred for angiography with a clinical suspicion of hepatic artery thrombosis had patent arteries. In an effort to reduce the number of negative angiograms, CT, real-time sonography, and pulsed Doppler have been evaluated as screening examinations to determine which patients need angiography. Of 14 patients with focal inhomogeneity of the liver architecture detected by CT and/or real-time sonography, 12 (86%) had hepatic artery thrombosis, one had slow arterial flow with hepatic necrosis, and one had a biloma with a patent hepatic artery. In 29 patients undergoing duplex sonography of the hepatic artery, six (21%) had absence of a Doppler arterial pulse. All six had abnormal angiograms: Four had thrombosis, one had a significant stenosis, and one had slow flow with biopsy-proven ischemia. Of 23 patients with a Doppler pulse, two had hepatic artery thrombosis at surgery. However, realtime sonography demonstrated focal inhomogeneity in the liver in both cases. Our data demonstrate that pulsed Doppler of the hepatic artery combined with real-time sonography of the liver parenchyma currently is the optimal screening test for selecting patients who require hepatic angiography after liver transplantation. A diagnostic algorithm is provided.Hepatic artery thrombosis after liver transplantation is a devastating event that requires immediate therapeutic intervention in most patients. The typical course is hepatic infarction followed by septic hepatic gangrene and septicemia. Emergency hepatic retransplantation is these patients' only hope for survival [1].In 1969, Starzl [2] described two cases of fatal hepatic artery thrombosis that were not initially recognized on the basis of clinical findings or laboratory studies. He concluded, "It is likely that aortography will prove to be the only really decisive way of consistently establishing the diagnosis while there is still time to attempt repair, providing the procedure is done at the first suspicion of a vascular accident." Since then, angiography has been the definitive procedure for evaluation of the hepatic artery after liver transplantation. availability of duplex sonography (combined real-time and pulsed Doppler), 33 angiographic studies (18 children and 15 adults) were performed at the University Health Center of Pittsburgh for the clinical suspicion of hepatic artery thrombosis after liver transplantation. Of these, 11 (61 %) of 18 children and 14 (93%) of 15 adults had patent hepatic arteries. It is clear that clinical criteria alone led us to perform an undesirably large number of normal arteriograms.We now use three noninvasive imaging techniques to evaluate the liver after transplantation: computed tomography (CT), real-time sonography, and...

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In a series of 28 patients with solitary solid thyroid masses, 10 of the patients had a mass surrounded by a rim of decreased echoes or by an echo-free rim, previously termed the halo sign. Eight of these lesions were benign, being either adenomas or benign nodules; however, two halos were also demonstrated surrounding proven carcinomas. The presence of the halo in both benign and malignant disease is illustrated, and the possibility of pericapsular inflammatory infiltrate as its underlying anatomic correlate is suggested.

In a retrospective study of proved pseudoaneurysms (PAs) in 15 patients with transplanted organs (11 liver, three kidney, one pancreas), the results of computed tomography (CT), duplex sonography, and angiography were reviewed. Of the 15 cases of PA, eight occurred at the arterial anastomosis and seven were nonanastomotic. Three of the eight anastomotic PAs were caused by infection. Of the seven nonanastomotic PAs, four were caused by percutaneous biopsy, two were caused by infection, and one was of undetermined cause. In nine (60%) of the 15 patients the PAs were incidentally detected at imaging studies performed for other reasons. Diagnosis requires a high degree of suspicion. CT was performed in nine cases and duplex sonography in ten. The diagnosis of PA was made with CT in six (67%) patients and with duplex sonography in five (50%). CT and duplex sonography could not enable diagnosis when the PA was small, when the arterial anastomosis was not included in the field of study, or when enhancement with intravenously administered contract material was suboptimal. Angiography depicted the PAs in all 15 patients. In three liver transplant recipients with gastrointestinal tract bleeding, the causative PAs were detected only with angiography.

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