Adrenal pseudotumors on CT due to dilated portosystemic veins

Ha, Mitty; Cohen, Burton A.; Sprayregen, Seymour; Schwartz, Kara M.

doi:10.2214/ajr.141.4.727

Cited by 21 publications

(6 citation statements)

References 10 publications

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“…Gastric veins may drain into esophageal/paraesophageal varices in approximately 84% of cases. 27 Occasionally gastric varices may drain via a gastrorenal shunt, which appears as a large leftsided inferior phrenic vein which connects the gastric varices to a dilated renal vein. This shunt may be recruited by existing tiny portosystemic collaterals from the adrenal venous system.…”

Section: Gastric Venous Collateral Pathwaysmentioning

confidence: 99%

“…This shunt may be recruited by existing tiny portosystemic collaterals from the adrenal venous system. 27 Large gastric varices are commonly seen in the absence of esophageal varices when a gastrorenal shunt is seen. Alternative pathways include direct drainage into the IVC by way of the left inferior phrenic vein or pericardiophrenic veins.…”

Section: Gastric Venous Collateral Pathwaysmentioning

confidence: 99%

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Portosystemic collateral pathways and interventions in portal hypertension

Bandali

Mirakhur

2018

Int J Gastrointest Interv

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Pathologic increase in portal pressure can be caused by increased resistance to blood flow at the level of the portal vein (pre-hepatic), hepatic sinusoids (hepatic) or hepatovenous outflow (post-hepatic). This results in recruitment and dilatation of tiny portosystemic collateral pathways, diverting portal venous blood flow to low pressure systemic veins. Based on the location of the causative factor of portal venous resistance, different collateral pathways and shunts may develop, resulting in unique syndromes of portal hypertension and in-turn requiring unique treatment options. Knowledge of the common and less-common portosystemic collateral pathways have important implication for clinicians and interventionalists. The objective of this pictorial review is to illustrate the various collateral pathways using diagrammatic and conventional non-invasive and invasive radiologic examples. Additionally, we will briefly address minimally invasive interventional techniques used to treat the sequelae of portal hypertension.

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Section: Gastric Venous Collateral Pathwaysmentioning

confidence: 99%

Section: Gastric Venous Collateral Pathwaysmentioning

confidence: 99%

Portosystemic collateral pathways and interventions in portal hypertension

Bandali

Mirakhur

2018

Int J Gastrointest Interv

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“…A gastrorenal shunt appears as a large left-sided retroperitoneal venous channel, associated with dilatation of the left renal vein[30]. These shunts may arise from pre-existing tiny portosystemic communications or from the adrenal and periadrenal venous system[30]. In patients with gastrorenal shunts, large gastric varices may be encountered in the absence of esophageal varices.…”

Section: Gastric Varices and Gastrorenal Shuntsmentioning

confidence: 99%

“…A spontaneous splenorenal shunt can also develop, which on CT, is seen as large, tortuous veins in the region of the splenic and left renal hilum that drain into an enlarged left renal vein (Figure 10)[30]. These shunts can be so tortuous that the exact origin of the connection along the splenic vein is sometimes difficult to discern.…”

Section: Perisplenic Varices and Splenorenal And Splenocaval/splenoazmentioning

confidence: 99%

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

Bandali

Mirakhur

Lee

et al. 2017

WJG

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Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

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“…Several cases of adrenal pseudotumor have been demonstrated [10][11][12][13][14][15][16][17]. Pseudotumors were approximately found in 0.7% of adrenal incidentalomas and preoperative discovery was only 0.1% of those.…”

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confidence: 99%

Gastric Diverticulum Simulating Left Adrenal Incidentaloma in a Hypertensive Patient

et al. 2007

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Abstract.A 46-year-old Japanese male with hypertension was referred for examination of left adrenal tumor incidentally detected by computed tomography (CT) scan. The patient had a 4-month history of hypertension. Abdominal CT demonstrated a low-density mass 2.5 cm in diameter in the left adrenal region that was observed as a high-intense lesion with T2-weighted magnetic resonance imaging. 131 I-adosterol scintigraphy showed normal uptake of bilateral adrenals. The adrenocortical hormone levels were within normal ranges; however, urinary noradrenaline excretion was slightly elevated, likely due to concurrent sleep apnea syndrome. Based on the observation of a very tiny bubble in the ventral portion of the adrenal mass by careful review of CT images examined at a previous hospital, a restudy of abdominal CT with oral contrast was performed. In this restudy abdominal CT we observed positive enhancement of the left adrenal mass, indicating that the adrenal mass was a diverticulum derived from posterior gastric fornix. The present case study reinforces that preoperative differentiation from mimic adrenal tumors is necessary in cases of cystic adrenal mass in the left adrenal region.

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Adrenal pseudotumors on CT due to dilated portosystemic veins

Cited by 21 publications

References 10 publications

Portosystemic collateral pathways and interventions in portal hypertension

Portosystemic collateral pathways and interventions in portal hypertension

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

Gastric Diverticulum Simulating Left Adrenal Incidentaloma in a Hypertensive Patient

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