Intrahepatic venous collaterals forming via the inferior right hepatic vein in 3 patients with obstruction of the inferior vena cava.

Abstract

When the inferior vena cava is obstructed, collateral veins enlarge, connecting with the inferior (accessory) right hepatic vein (IRHV) and thence through various hepatic veins to the right atrium. Three such cases are described. In one patient, most contrast material flowed into the IRHV and from there to the left hepatic vein. The second patient had several large collaterals arising from the IRHV and flowing into the right and middle hepatic veins, while the third patient demonstrated anastomoses between the IRHV and the middle hepatic vein. All of these hepatic venous shunts eventually drained into the right atrium. There were no clinical manifestations such as ascites, edema, or dilatation of the abdominal veins. Cavography alone or combined with computed tomography proved to be diagnostic in the assessment of these intrahepatic collaterals.

Ultrasonographic Visualization of Accessory Hepatic Veins and Their Lesions in Budd–Chiari Syndrome

“…Therefore, blood from the IVC reverses to the AHVs, through the enlarged intrahepatic collaterals and draining hepatic veins (orifice above occlusion), and finally to the right atrium. This blood-draining pathway relieves the symptoms caused by portal hypertension and IVC hypertension (Akaki et al 1995;Kamba et al 1995;Takayasu et al 1985). Hepatopetal flow in AHVs can be clearly observed on ultrasonography, on which basis a definite diagnosis can be made (Gai et al 2014a(Gai et al , 2014b.…”

Diagnosis of the cavo-hepato-atrial pathway in Budd-Chiari syndrome by ultrasonography

“…Compared with other collateral circulations (5,6), this pathway is a direct route of drainage from the IVC to the right atrium (7). The pathological change is that blood pressure below the obstructed portion of the IVC exceeds that of the hepatic veins.…”

“…The pathological change is that blood pressure below the obstructed portion of the IVC exceeds that of the hepatic veins. The continuously increasing pressure in the IVC produces small anastomoses between adjacent intrahepatic veins, which eventually develop into enlarged collaterals (5). Therefore, the hemodynamics of the IVC and hepatic/accessory hepatic veins change accordingly.…”

“…In western countries, BCS is often caused by prothrombotic disorders; whilst membranous or segmental obstruction of the IVC is the most common cause of BCS in Asia (1–4). Following obstruction of the IVC, collateral circulation may be developed via azygous, lumbothoracic, intercostal, inferior phrenic and abdominal veins or the portal venous system (5,6). However, blood within the occluded IVC may also be drained to the right atrium by another route, the cavo-hepato-atrial pathway.…”

Hepatic lipomas: Ultrasound and computed tomographic findings

“…Lipoma can be diagnosed when densitometric analysis gives a density reading between -2 0 and -1 1 5 H U [7,10]. For lesions with an adenomatous or angiomatous component, injection of contrast material can result in enhancement that is responsible for a positive density [8].…”