Portal Cavernomatosis: US, CT and MR imaging findings of portal vein thrombosis

Congress:

ECR 2018

Poster Number:

C-0323

Type:

Educational Exhibit

Keywords:

Haemodynamics / Flow dynamics, Embolism / Thrombosis, Cirrhosis, Contrast agent-intravenous, Ultrasound-Colour Doppler, MR, CT, Veins / Vena cava, Liver, Abdomen

Authors:

S. Pellegrino¹, D. Giambelluca¹, M. Dimarco¹, G. Caruana¹, M. R. VACCARO NOTTE², D. Picone¹, T. V. Bartolotta¹, S. Salerno¹, R. Lagalla¹; ¹Palermo/IT, ²PALERMO, ITALIA/IT

DOI:

10.1594/ecr2018/C-0323

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0323

Fig. 1: CT- MPR - Coronal view - Portal Phase - shows a case of intrahepatic cavernoma...

Fig. 2: MRI - T1 Portal Phase- shows a case of intrahepatic cavernoma (arrows). 76...

Fig. 6: CT Portal Phase. Caudate Lobe Ipertrophy (arrows).

Fig. 7: CT Portal Phase. IV segment Ipertrophy (arrows).

Learning objectives

In this educational exhibit we propose to achieve these objectives: - To recognize the imaging appearance of cavernous transformation of portal vein; - To identify perfusion anomalies associated with changes in portal venous thrombosis; - To provide brief notes about the related liver and vascular alterations.

Background

The blood flow of the liver implies around 25-30% of the cardiac output, which is about 1500ml/min. Liver receives this blood supply from two different sources: the portal vein and the hepatic artery. However, a part of the splanchnic venous flow does not join the portal vein in the extrahepatic portion: these veins enter the liver independently and flow directly into the hepatic sinusoids. Such aberrant veins are called "third inflow" vessels to the liver. There are two kinds of third inflow veins that supply...

Findings and procedure details

MRI, CT and Doppler ultrasound can be useful in detecting these pathologies by identifying the most common signs. Sonography usually shows PVT as a hyperechoic lesion within the lumen of the portal vein. However, clots exhibit variable echogenicity and may, if recently formed, be hypoechoic or anechoic. PVT eliminates the venous flow signal normally obtained from the lumen of the portal vein during either pulsed duplex or color flow Doppler imaging (Fig. 3) [3]. CTPV is seen as a mass of tubular anechoic collaterals within...

Conclusion

PVT and CTPV may be consequential events, remain commonly asymptomatic and their detection is usually incidental. Familiarity with the various imaging findings and the clinical features is crucial for their accurate diagnosis and the appropriate management.

Personal information

Silvia Pellegrino, [email protected]

References

1. Akinobu Osame, Toshimichi Mitsufuji, Shinichi Kora, Kengo Yoshimitsu, Daisuke Morihara, Hideo Kunimoto. Focal fatty change in the liver that developed after cholecystectomy; World J Radiol 2014 December 28; 6(12): 932-936 ISSN 1949-8470. 2. Anna Maria De Gaetano, Michel Lafortune, Heidi Patriquin, Antonio De Franco, Benolt Aubin, Khazal Paradis. Cavernous Transformation of the Portal Vein: Patterns of lntrahepatic and Splanchnic Collateral Circulation Detected with Doppler Sonography; AJR Am J Roentgenol 1995 Nov;165(5):1151-5. 3. H. Richard Parvey, Bharat Raval, and Carl M. Sandier. Portal Vein Thrombosis:...