Sinistral Portal Hypertension: Computed Tomography Imaging Findings and Clinical Appearance—A Descriptive Case Series

Kul, Melahat; Haliloğlu, Nuray; Hürsoy, Nur; Erden, Ayşe

doi:10.1016/j.carj.2018.07.006

Cited by 13 publications

(14 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This reversal of flow may result in hypertension with secondary gastric/gastroesophageal varices (GVs), considered major sources for the gastrointestinal bleeding in regional splenic vein hypertension 3,11,12 . Furthermore, this syndrome is often associated with splenomegaly and normal liver function, with presence of GVs only in 35–45% of the cases 11 . Splenectomy attenuates the arterial inflow into the left portal system and results in decompression of the concurrent gastric varices 11,12 …”

Section: Discussionmentioning

confidence: 99%

“… 3 , 11 , 12 Furthermore, this syndrome is often associated with splenomegaly and normal liver function, with presence of GVs only in 35–45% of the cases. 11 Splenectomy attenuates the arterial inflow into the left portal system and results in decompression of the concurrent gastric varices. 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

“… 11 Splenectomy attenuates the arterial inflow into the left portal system and results in decompression of the concurrent gastric varices. 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Ultrasonographic and CT diagnosis of a complete splenic duplication with right splenic torsion and presumed regional splenic vein hypertension in a dog

Battiato

Salgüero²,

Specchi³

et al. 2021

Vet Radiology Ultrasound

View full text Add to dashboard Cite

An 8‐year‐old mixed breed dog, was referred for lethargy, abdominal discomfort, hematemesis, and melena. Abdominal ultrasound revealed mineralization of the “right splenic vein” with collateral spiraling and a suspected splenic duplication. Computed tomography confirmed the duplication along with torsion of the splenic pedicle. Exploratory laparotomy confirmed the splenic torsion associated with congestion of the gastrointestinal vessels, indicative of a chronic onset of secondary regional splenic vein hypertension.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasonographic and CT diagnosis of a complete splenic duplication with right splenic torsion and presumed regional splenic vein hypertension in a dog

Battiato

Salgüero²,

Specchi³

et al. 2021

Vet Radiology Ultrasound

View full text Add to dashboard Cite

show abstract

“…Results of the present study demonstrated that regional splenic hyper- Independently of the cause of the SV occlusion, due to the back pressure into the left side of the portal system, variation in the blood flow between the SV and gastroepiploic or gastric veins can develop. 4 In the current study, authors considered CT to be a useful tool to assess both the underlying cause of SV occlusion and the collateral splenosystemic circulation. In one dog, we identified a splenogonadal pathway, which is commonly seen in portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

CT angiography identifies collaterals in dogs with splenic vein obstruction and presumed regional splenic vein hypertension

Specchi¹,

Bertolini

2020

Vet Radiology Ultrasound

View full text Add to dashboard Cite

Occlusion of the splenic vein, without occlusion of the portal vein, can lead to a localized, regional splenic hypertension, referred as sinistral or left-sided portal hypertension in the human radiology literature. In people, may cause gastrointestinal hemorrhages from the esophageal and gastric varices and the primary pathology usually includes pancreatitis and pancreatic neoplasms. The final diagnosis of localized splenic hypertension necessitates accompanying normal liver functions and a patent extrahepatic portal vein. Following obstruction, the resultant elevated splenic bed venous pressure causes formation of collateral routes, the extent of which depends upon the level and degree of obstruction. In this retrospective descriptive study, authors assessed the collateral pathways in dogs with isolated splenic vein occlusion and possible regional splenic vein hypertension. Out of the 46 patients initially recruited, 25 were excluded due to the presence of concomitant portal thrombosis and direct/indirect CT signs of portal hypertension. The remaining 21 dogs had clinicopathological tests suggesting normal liver function. The causes of obstruction identified included splenic pedicle torsion, tumoral splenic vein invasion, and splenic vein thrombosis. Four of 21 dogs with isolated splenic vein obstruction showed collateral pathways through the left gastroepiploic vein (4/4), left gastric vein (2/4), and splenogonadal vein (1/4). The diagnosis of isolated, regional splenic hypertension should be based on clinical, biochemical, and radiological evaluation. Computed tomography is an excellent tool to assess the collateral patterns and to determine the underlying cause.

show abstract

“…Patients with AP who had no signs of liver disease but had isolated gastric varices and/or splenomegaly were considered to have SPH ( 3 , 11 ). The presence of collaterals vessels was defined as disproportionate increases in the caliber and in the number of vessels in any location.…”

Section: Methodsmentioning

confidence: 99%

Dynamic Changes and Nomogram Prediction for Sinistral Portal Hypertension in Moderate and Severe Acute Pancreatitis

et al. 2022

View full text Add to dashboard Cite

ObjectivesTo investigate the dynamic changes in gastric varices in patients with acute pancreatitis (AP) and to develop a novel nomogram for the early prediction of sinistral portal hypertension (SPH).MethodsThis was a retrospective, case-control study with an analysis of the quantitative, dynamic computed tomography imaging results of SPH in patients with moderate and severe AP with a long-term follow-up. Multivariate logistic regression analysis and nomogram were employed.ResultsThe SPH group (n = 94) and non-SPH group (n = 94) were matched. The dynamic changes showed an increasing trend in the diameter of gastric fundus, short gastric, gastric coronary, and gastroepiploic veins, which did not recover during the one-year follow-up. Multivariate analysis showed that male (adjusted odds ratio (adjOR), 8.71; 95% confidence interval (CI), 2.86–26.53; P < 0.001), body mass index ≥27.5 kg/m2 (adjOR, 5.49; 95% CI, 1.85–16.29; P = 0.002), prothrombin time ≥12.6 s (adjOR, 2.82; 95% CI, 1.11–7.17; P = 0.03), and the patency of splenic vein [stenosis (adjOR, 8.48; 95% CI, 2.13–33.71; P = 0.002), and occlusion (adjOR, 34.57; 95% CI, 10.87–110.00; P < 0.001)] were independently associated with the development of SPH. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.92 (95% CI, 0.87–0.95).ConclusionThe dynamic changes in varices in SPH are long-term and slowly progressing. Males and obese patients with abnormal splenic veins and coagulopathies are at high risk for developing SPH. A simple nomogram tool helps in the early, accurate prediction of SPH.

show abstract

Sinistral Portal Hypertension: Computed Tomography Imaging Findings and Clinical Appearance—A Descriptive Case Series

Cited by 13 publications

References 25 publications

Ultrasonographic and CT diagnosis of a complete splenic duplication with right splenic torsion and presumed regional splenic vein hypertension in a dog

Ultrasonographic and CT diagnosis of a complete splenic duplication with right splenic torsion and presumed regional splenic vein hypertension in a dog

CT angiography identifies collaterals in dogs with splenic vein obstruction and presumed regional splenic vein hypertension

Dynamic Changes and Nomogram Prediction for Sinistral Portal Hypertension in Moderate and Severe Acute Pancreatitis

Contact Info

Product

Resources

About