Coronary vein diameter and flow direction in patients with portal hypertension: evaluation with duplex sonography and correlation with variceal bleeding.

Wachsberg, Ronald H.; Simmons, Marc

doi:10.2214/ajr.162.3.8109512

Cited by 46 publications

(23 citation statements)

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“…In control subjects, the diameter of the coronary vein measured up to 6 mm. In patients with portal hypertension, dilatation of the coronary vein was seen in 26 % of cases, whereas hepatofugal flow in the coronary vein was seen in 78 % of the patients [31]; therefore, we can consider that hepatofugal flow may be a very sensitive indicator of portal hypertension.…”

Section: Splanchnic Veinsmentioning

confidence: 90%

Ultrasound of diffuse liver disease and portal hypertension

Vilgrain

2001

Eur Radiol

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Section: Splanchnic Veinsmentioning

confidence: 90%

Ultrasound of diffuse liver disease and portal hypertension

Vilgrain

2001

Eur Radiol

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“…Of interest is the fact that, although the precise mechanism remains unknown, gastric varices associated with esophageal varices had a higher prevalence for hemorrhaging than did isolated gastric varices. A close relationship between the presence of esophageal varices and the reversal (hepatofugal) of flow in the left gastric vein has also been emphasized [12], which leads us to speculate that color Doppler sonography enabled us to differentiate roughly two gastric varicose groups by observing the flow direction in the left gastric vein: those with a high risk for hemorrhage and those with a low risk for hemorrhage.…”

Section: Discussionmentioning

confidence: 89%

Color Doppler findings of gastrointestinal varices

et al. 1998

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Color Doppler sonography was very useful for the diagnosis of gastric and duodenal varices and for visualizing fine venous flows in the thickened gastric or duodenal wall. When it shows portal thrombosis in the confluence of the splenic vein and the superior mesenteric vein, duodenal varices should be suspected. The flow direction of the left gastric vein helps to differentiate hemorrhagic gastric varices from nonhemorrhagic ones.

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“…In some patients with portal hypertension, it has been reported that the portal flow is hepatofugal. 3 In our patient, the exact causes of the metastasis are unknown, but they may be related to factors such as the blood flow in the left gastric vein, tumor histocompatibilty, or angiogenetic factors. Several patients with gastric or hepatic cancer have been reported to have serial portal thromboses and metastases to the left gastric vein.…”

mentioning

confidence: 85%

Metastasis of hepatic angiosarcoma to the gastric vein

Nakayama

Masuda

Fukuzawa

et al. 2004

Journal of Gastroenterology

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A 29-year-old female clerical worker was admitted to hospital with sudden right upper quadrant pain in September 1994. Her family history was noncontributory, and there was no prior exposure to vinyl chloride monomer, Thorotrast (thorium dioxide), or arsenic. Results of blood chemistry analyses, including alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 were normal. Computed tomography (CT) disclosed heterogeneous liver tumors in segment 5 (1.5 cm) and segment 6 (5.0 cm), and angiography showed deep tumor staining with neovascularization. A malignancy was suspected and the patient underwent laparotomy. Tumors were removed by wedge resections and surgical margins of 8 mm were obtained. Pathological findings were consistent with diagnostic criteria 1 for primary hepatic angiosarcoma (PHA) (Fig. 1).Two years and 6 months later, the patient was found to have a recurrence. Ultrasonography revealed a 1.5-cm hypoechoic lesion near the portal trunk. Three-dimensional CT revealed a nodule in the left gastric vein (Fig. 2a). Extrahepatic recurrence was suspected, and a laparotomy was performed. A solid 1.5-cm tumor was detected directly under the lesser omentum. The tumor formed a solid lesion protruding into the left gastric vein, which diverged from the portal trunk. There was no infiltration outside the vascular wall. Tumor embolism in the portal trunk, peritoneal metastasis, and splenic metastasis were not seen. The cephalic side of the tumor was cut with an adequate surgical margin from the gastric wall. As the caudate side of the tumor extruded into the portal trunk, it was resected by a side clamp of the portal trunk. Thus, the tumor was removed with resection of the left gastric vein (Fig. 2b). The pathological findings were similar to those of the PHA, which indicated that the tumor in the left gastric vein was a metastasis. The surgical margins were tumorfree. At present, 6 years after the second operation, the patient is healthy, with no signs of recurrence.This patient had PHA that revealed heterochronous metastasis only to the left gastric vein. PHA, a rare mesenchymal tumor, can be induced by Thorotrast or vinyl chloride monomer. Reportedly fatal metastatic sites include the lung (35%), bone (18%), and spleen (18%). 1 Strategies for treating PHA have not been confirmed, and the prognosis for these patients has been hopeless. 2

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Coronary vein diameter and flow direction in patients with portal hypertension: evaluation with duplex sonography and correlation with variceal bleeding.

Abstract: OBJECTIVE.The purpose of this study was to compare the diameter of the coronary vein and the direction of flow within it between patients with portal hypertension and control subjects. SUBJECTS AND METHODS. We used pulsed

Cited by 46 publications

References 1 publication

Ultrasound of diffuse liver disease and portal hypertension

Ultrasound of diffuse liver disease and portal hypertension

Color Doppler findings of gastrointestinal varices

Metastasis of hepatic angiosarcoma to the gastric vein

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