Congenital and Acquired Anomalies of the Portal Venous System

Gallego, Carmen; Velasco, María; Marcuello, Pilar; Tejedor, Daniel; Campo, Lourdes De; Friera, Alfonsa

doi:10.1148/radiographics.22.1.g02ja08141

Cited by 252 publications

(165 citation statements)

References 43 publications

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“…If the thrombosis develops gradually, it may lead to the formation of a cavernoma. In contrast, acute thrombosis of the portal vein is heralded by sudden liver failure that is similar to that is seen with hepatic artery thrombosis [6,17]. Portal vein thrombosis can be easily diagnosed with Doppler ultrasound, and any doubts that arise can be resolved with more invasive procedures (CT, MRI, or the imaging modality of choice in cases like this, portography) [18].…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Bonini

Pezzotta

Morzenti

et al. 2007

Journal of Ultrasound

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KEYWORDSSplit liver; Pediatric liver transplantation; Complications; Contrast-enhanced sonography.Abstract Purpose: To evaluate the utility of contrast-enhanced sonography in the study of pediatric liver transplant recipients and its potential impact in reducing the need for invasive diagnostic procedures. Materials and methods: From October 2002 to December 2003 we performed routine color Doppler ultrasound and contrast-enhanced ultrasound studies on 30 pediatric patients who had undergone liver transplantation. Findings indicative of complications were confirmed with invasive studies (angiography, computed tomography, and PTC). Results: Contrast-enhanced sonography correctly identified four of the five cases of hepatic artery thrombosis and all those involving the portal (n Z 6) and hepatic vein (n Z 3) thrombosis. It failed to identify one case of hepatic artery thrombosis characterized by collateral circulation arising from the phrenic artery and the single case of hepatic artery stenosis. The latter was more evident on color Doppler, which revealed a typical tardus parvus waveform. The use of contrast offered no significant advantages in the study of biliary complications although it did provide better visualization of bile leaks. Conclusions: Contrast-enhanced sonography improves diagnostic confidence and reduces the need for more invasive imaging studies in the postoperative follow-up of pediatric liver transplant recipients.Sommario Scopo: Valutare l'utilità dell'ecografia con mezzo di contrasto (Mdc) ecografico di II generazione nel paziente pediatrico trapiantato di fegato, in particolare al fine di ridurre il ricorso a metodiche diagnostiche invasive. ha fornito dati falsamente negativi in un caso di trombosi dell'arteria epatica, ricanalizzata da rami provenienti dall'arteria frenica, e nell'unico caso di stenosi anastomotica dell'arteria epatica della nostra casistica, nel quale è stato indicativo il pattern ''tardus parvus'' osservato all'esame eco-Doppler. Nel caso delle complicanze biliari l'esame eco-contrastografico non ha apportato significativi vantaggi, se non una migliore definizione dei margini e dell'estensione delle raccolte biliari post-intervento. Conclusioni: L'esame ecografico con Mdc è metodica in grado di incrementare la confidenza diagnostica dell'operatore, consentendo una riduzione al ricorso ad esami radiologici invasivi; ciò è particolarmente importante nel caso di pazienti a rischio, quali i bambini sottoposti a trapianto epatico. ª 2007 Published by Elsevier Masson.

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Bonini

Pezzotta

Morzenti

et al. 2007

Journal of Ultrasound

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“…The right portal vein gives rise to a branch that supplies the caudate lobe and then to anterior and posterior branches, which in turn subdivide to form two superior and two inferior branches for the four segments. The left branch runs horizontally, crossing over the round ligament (umbilical segment), where it gives rise to two branches that supply the II and III segments followed by two terminal branches that supply the IV segment [4].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound examination of the liver: Variations in the vascular anatomy

Battaglia

Fachinetti

Draghi

et al. 2010

Journal of Ultrasound

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The hepatic vasculature is highly complex. The hepatic artery (a branch of the celiac tripod) and the portal vein (formed by the confluence of the splenic and superior mesenteric veins) provide a dual blood supply while venous drainage is guaranteed by the hepatic veins. There are also numerous anatomic variants that can involve one or more of the system's three components.Hepatic artery variants are the least common. Ten types have been identified, including several that are fairly frequent and others that are quite rare, and the variation generally involves the extrahepatic portion of the vessel. Portal vein variants are found in around 20% of the population. They can involve the main portal trunk or segmental branches. Variants of the hepatic veins are the most common. They involve the number and course (supernumerary veins) or the number, course, and openings (accessory veins).Knowledge of portal vein and hepatic vein variants, which are extremely common, is of prime importance for precise localization of lesions. Hepatic artery variants are equally important for surgical treatment of hepatic disease, especially liver transplantation, where it is essential for preoperative workup and postoperative follow-up of the recipient as well as for assessment of potential donors.Sommario La vascolarizzazione del fegato è complessa: arteria epatica, ramo del tripode celiaco, e vena porta, costituita dalla confluenza delle vene splenica e mesenterica superiore, forniscono una doppia vascolarizzazione; mentre il drenaggio è assicurato dalle vene sovrepatiche, inoltre vi è un numero significativo di varianti che possono interessare separatamente o contemporaneamente i tre i sistemi.Le varianti dell'arteria epatica, meno frequenti rispetto alle altre, sono state classificate in dieci tipi di cui alcuni più comuni, altri del tutto eccezionali, riguardano principalmente il tratto extra-epatico del vaso. Quelle della vena porta, che si riscontrano in circa il 20% della popolazione, possono interessare sia i rami principali che i segmentari. Quelle delle vene sovrapatiche, le più frequenti, possono riguardare il numero ed il decorso (vene soprannumerarie) o il numero ed il decorso, ma anche lo sbocco (vene accessorie). La conoscenza delle varianti portali e delle vene sovrepatiche, estremamente frequenti, è di primaria importanza per la possibilità di localizzare con precisione eventuali lesioni; non meno importante è la conoscenza delle varianti dell'arteria epatica, in relazione alle terapie chirurgiche, in particolare per quello che riguarda i trapianti, sia nella fase pre-operatoria, sia nella valutazione del potenziale donatore, sia nel follow-up. ª

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“…Arterial and direct portography as well as splenoportography may also be used. Doppler ultrasound is the best way in making the decisive diagnosis and helpful in the subsequent evaluation of these patients [4,5] . Angiography is the most useful test because it can not only identify multiple APFs but also be therapeutic.…”

Section: Discussionmentioning

confidence: 99%

A large congenital and solitary intrahepatic arterioportal fistula in an old woman

Lu¹,

Ao²,

Peng³

et al. 2009

WJG

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Arterioportal fistula (APF) is a rare cause of portal hypertension and may lead to death. APF can be congenital, post-traumatic, iatrogenic (transhepatic int e rve nt ion or biopsy) or related to ruptured hepatic artery aneurysms. Congenital APF is a rare condition even in children. In this case report, we describe a 73-year-old woman diagnosed as APF by ultrasonography, computed tomography, and hepatic artery selective arteriography. The fistula was embolized twice but failed, and she still suffered from alimentary tract hemorrhage. Then, selective arteriography of the hepatic artery was performed again and venae coronaria ventriculi and short gastric vein were embolized. During the 2-year follow-up, the patient remained asymptomatic. We therefore argue that embolization of venae coronaria ventriculi and short gastric vein may be an effective treatment modality for intrahepatic APF with severe upper gastrointestinal bleeding.

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Congenital and Acquired Anomalies of the Portal Venous System

Cited by 252 publications

References 43 publications

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Ultrasound examination of the liver: Variations in the vascular anatomy

A large congenital and solitary intrahepatic arterioportal fistula in an old woman

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