Retroperitoneal varices simulating masses

Abstract

Retroperitoneal varices in portal hypertension may simulate the appearance of neoplastic masses or adenopathy. Contrast-enhanced CT scans clarify the diagnosis of large vascular channels. Three patients with large retroperitoneal varices demonstrated on CT had confirmation by angiography.The venous collaterals in portal hypertension are usually best shown by angiographic techniques [1][2][3][4]. However,the use of computed tomography [CT) to demonstrate thoracic and abdominal varices in patients with portal hypertension has been recently described [5,6]. The purpose of this paper is to report 3 cases in which large retroperitoneal varices resembled tumor masses. Awareness that varices can simulate masses on non-contrast-enhanced CT scans may obviate an erroneous CT diagnosis. MethodsCT examinations were performed on a Delta 50 FS (case 1) or EMI 5005 (cases 2 and 3) scanner. Slice width was 13 mm with either contiguous (13 ram) or overlapping (10 ram) space increments. Intravenous contrast consisted of a bolus injection of 60-120 ml Renografin 60 (diatrizoate meglumine and diatrizoate sodium). Case 1 received a bolus injection of Renografin 60 followed by 300 ml Reno M Dip (diatrizoate meglumine). Case Reports Case ]A 58-year-old man with a history of alcohol-induced liver disease and hepatic encephalopathy was admitted for obtundation. During hospitalization, he became septic due to a urinary tract infection.

A Case of Solitary Varices Arising from the Retroperitoneum

“…Varices in retroperitoneum due to portal hyperten sion (gastrorenal collaterals, splenorenal collaterals, pan creaticoduodenal hemiazygos collaterals and superior mesenteric-caval (right-renal) collaterals) are well known [1,2]. However, our case did not show any subjective and objective evidence of portal hypertension, although he had had a history of B-type hepatitis.…”

“…Varices arising from the retroperitoneum are not rare [1,2], The usual cause of varices is portal hypertension due to liver disease. We report the second case of solitary retroperitoneal varices unrelated to portal hyperten sion.…”

Three-dimensional Multi–Detector Row CT Portal Venography in the Evaluation of Portosystemic Collateral Vessels in Liver Cirrhosis

“…Among the collateral pathways, esophageal varices are of particular clinical importance because they are a common source of upper gastrointestinal bleeding (20,21). Although endoscopy is the most reliable diagnostic procedure for detecting esophageal varices, the extent of esophageal varices and associated paraesophageal varices is better visualized at CT or MR imaging (22).…”

Mesenteric venous collateral vessels mimicking cystic pancreatic neoplasm

“…Varices affecting the duodenum [7], small bowel [8], stomach [9], kidneys [10] and retroperitoneum [11] have also been reported. Isolated perigastric varices may develop in cases of splenic vein thrombosis or following spleen-preserving pancreatectomy, where splenic arteriovenous structures are ligated or resected [12].…”