Patent paraumbilical vein on ultrasound: not always cirrhosis

Congress:

ECR 2018

Poster Number:

C-2303

Type:

Educational Exhibit

Keywords:

Tropical diseases, Connective tissue disorders, Cirrhosis, Education, Ultrasound-Spectral Doppler, Ultrasound-Colour Doppler, Ultrasound, Veins / Vena cava, Liver, Abdomen

Authors:

J. C. Nogueira Junqueira¹, A. Cavalanti¹, M. C. Chammas¹, H. Durante², S. M. Ando¹; ¹São Paulo/BR, ²SÃO PAULO, SP/BR

DOI:

10.1594/ecr2018/C-2303

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2303

Fig. 1: Simplified scheme demonstrating the umbilical vein and the paraumbilical veins.

Fig. 7: Ultrasound Doppler image of a typical patent paraumbilical vein with...

Fig. 8: Ultrasound Doppler image of a typical patent paraumbilical vein with...

Fig. 6: Coronal and sagittal multiplanar reformation (MPR) images from enhanced...

Fig. 18: Budd-Chiari Syndrome due to chronic complete IVC thrombosis in a patient with...

Fig. 21: Behçet's disease (Figs. 21-23). 1) Chronic thrombosis of the IVC, sparing its...

Learning objectives

To review the anatomy of the paraumbilical veins. To discuss the pathologies in which they can become enlarged. To highlight associated ultrasound findings that help establish the correct diagnosis.

Background

THE UMBILICAL VEIN In adults, the umbilical vein is usually completely occluded, mainly in its distal part, forming the round ligament, a fibrous structure. A very thin patent remnant of the umbilical vein may be present in connection with the left branch of the portal vein in normal individuals. It is called the Baumgarten’s recess [1]. THE PARAUMBILICAL VEINS The paraumbilical veins are found around the falciform ligament next to the round ligament. They are composed by Burow's veins and Sappey's inferior and superior veins...

Findings and procedure details

As previously explained, the paraumbilical veins can become dilated and allow blood flow away from the liver (hepatofugal direction) or towards the liver (hepatopetal). The first being related to PORTAL HYPERTENSION and the second to CHRONIC EXTENSIVE INFERIOR VENA CAVA THROMBOSIS. We present a series of cases of patent paraumbilical veins found on ultrasound examination divided by mechanism of occurrence and etiology. PORTAL HYPERTENSION In this scenario, the increase of the blood pressure inside the portal system, notably in the left branch of the portal...

Conclusion

A patent paraumbilical vein during ultrasound examination points towards portal hypertension or IVC thrombosis. Studying the direction of the blood flow and seeking associated findings is mandatory for establishing the correct diagnosis.

Personal information

Contact details: Dr. José Claudio Nogueira Junqueira Resident in training. Instituteof Radiology (InRAD), Hospital das Clínicas of the University of São Paulo (USP). Travessa da Rua Dr. Ovídio Pires de Campos, 75, CEP 05403-010, Cerqueira César - São Paulo/SP, Brazil. Email: [email protected] Dr. Maria Cristina Chammas Chief of the Ultrasounddivision. Instituteof Radiology (InRAD), Hospital das Clínicas of the University of São Paulo (USP). Travessa da Rua Dr. Ovídio Pires de Campos, 75, CEP 05403-010, Cerqueira César - São Paulo/SP, Brazil. Email:mcchammas@hotmail.com Dr. Andrea Cavalanti Gomes...

References

Lafortune M, Constantin A, Breton G, et al. The recanalized umbilical vein in portal hypertension: a myth. American Journal of Roentgenology 1985; 144:549 – 553. Martin BF, Tudor RG. The umbilical and paraumbilical veins of man. Journal of Anatomy 1980; 130: 305–322. Yeh HC, Stancato-Pasik A, Ramos R, Rabinowitz JG. Paraumbilical venous collateral circulations: color Doppler ultrasound features. Journal of Clinical Ultrasound 24:359–363, 1996. Isogai J, Sakamoto H, Asahi JP, Tsukuba JP. Cruveilhier-Baumgarten syndrome: anatomical and pathologic imaging of periumbilical venous network. Poster C-0442. ECR...