Learning objectives
Describe the embryology of extrahepatic portosystemic shunts
Recognize the characteristic imaging findings of inferior mesenteric vein shunts (morphology,
pathway,
drainage level,
and size),
classify them in different types and search potential association with other portosystemic shunts
Analyze their connection with portal hypertension,
hepatic encephalopathy or hepatic diseases
Background
PORTAL SYSTEMIC COLLATERAL VESSELS:
Portosystemic collateral vessels develop in patients with portal hypertension as a way to decompress the splachnic flow,
and they can be divided into two groups depending on whether they drain toward the superior vena cava (SVC)or the inferior vena cava (IVC).
- Collateral vessels draining into the SVC include the left gastric vein (coronary),
short gastric vein,
posterior gastric vein,
gastric varices,
esophageal and paraesophageal varices.
- Vessels draining into the IVC include gastrorenal and splenorenal shunts,
paraumbilical vein and abdominal...
Imaging findings OR Procedure details
We retrospectively reviewed 12 cases of inferior mesocaval shunts (IMS) identified in our tertiary referral hospital between 2004 and 2010,
including 6 men and 6 women aged between 41-82 years (mean age 64’7 years),
who underwent abdominal MDCT for different purposes,
the most frequent one for evaluating liver disease. This is,
to the best of our knowledge,
the largest serie reported (Table 3).
10 of 12 patients had chronic hepatopathy,
including Hepatitis B Virus,
alcoholic diseases and unknown cause,
and none of them had a...
Conclusion
It’s important to recognize the MDCT findings of IMVS that allow its identification and classification,
since there are important clinical manifestations associated.
Knowledge of the imaging features and the drainage pathways are also critical to guide the treatment strategy for symptomatic shunts.
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