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Liver: Portal Vein Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Liver ❯ Portal vein

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  • “In particular, the significance of these aneurysms must be appreciated in the emergency setting, as portal vein aneurysms can rarely present with symptoms of abdominal pain and other complications (such as thrombosis, portal hypertension, rupture, embolism, and compression of the duodenum and inferior vena cava) making surgical repair necessary.”
    Portal Vein Aneurysms: Imaging Manifestations and Clinical Significance
    Dalal PS, Raman SP, Horton KM, Fishman EK
    Emerg Radiol 2013 May 23 (Epub ahead of print)
  • “ Although portal vein aneurysms (PVAs) are the most common of the visceral venous aneurysms (>95%), they are quite rare and account for only 3% of all venous aneurysms.”
    Portal Vein Aneurysms: Imaging Manifestations and Clinical Significance
    Dalal PS, Raman SP, Horton KM, Fishman EK
    Emerg Radiol 2013 May 23 (Epub ahead of print)
  • “A portal vein aneurysm is defined as a focal dilatation of the portal venous system, a dilatation which present with a number of different shapes/morphologies (i.e. saccular, fusiform, bilobular). Studies suggest that a fusiform shape may be the most common, followed by saccular and bilobular aneurysms.”
    Portal Vein Aneurysms: Imaging Manifestations and Clinical Significance
    Dalal PS, Raman SP, Horton KM, Fishman EK
    Emerg Radiol 2013 May 23 (Epub ahead of print)
  • “Aneurysms of the intrahepatic portal vein branches tend to be smaller than extrahepatic aneurysms, possibly due to the restrictive effects of the liver parenchyma on intrahepatic aneurysm growth . Accordingly, extrahepatic portal venous dilatation is considered to be “aneurysmal” after exceeding 2 cm in diameter, while intrahepatic portal vein branches are considered to be “aneurysmal” when they exceed 0.7 cm in diameter in patients without relevant risk factors and 0.85 cm in diameter in cirrhotic patients.”
    Portal Vein Aneurysms: Imaging Manifestations and Clinical Significance
    Dalal PS, Raman SP, Horton KM, Fishman EK
    Emerg Radiol 2013 May 23 (Epub ahead of print)
  • “Most people with portal venous system aneurysms remain asymptomatic . However, in some rare cases, patients can present with abdominal or back pain and gastrointestinal bleeding. While extraordinarily rare, patients have also been described as presenting with fever, abdominal swelling, jaundice, weight loss, and malaise. The most significant complications of PVAs include thrombosis, portal hypertension, rupture, embolism, and compression of the duodenum and inferior vena cava.”
    Portal Vein Aneurysms: Imaging Manifestations and Clinical Significance
    Dalal PS, Raman SP, Horton KM, Fishman EK
    Emerg Radiol 2013 May 23 (Epub ahead of print)
  • “Finally, our center has found the utilization of 3D technique to be extraordinarily helpful in guiding our surgeons in the management of these aneurysms.  In particular, maximum intensity projection (MIP) and volume rendering (VR) techniques allow improved visualization of the aneurysm in three dimensions, and allow our surgeons to understand the aneurysm’s morphology and its relationship to adjacent structures, features that are critical in surgical planning.”
    Portal Vein Aneurysms: Imaging Manifestations and Clinical Significance
    Dalal PS, Raman SP, Horton KM, Fishman EK
    Emerg Radiol 2013 May 23 (Epub ahead of print)
  • “Portal vein aneurysms are rare findings, without clearly defined criteria for diagnosis, management, or treatment in the literature. Currently, management is largely determined on a case-by-case basis, and each patient with a PVA must be managed in light of their individual underlying risk factors, the location of their aneurysm in relationship to other adjacent structures, and the growth of the aneurysm over time.  Despite this ambiguity, CT can be an extremely helpful tool in terms of both diagnosis and management. Notably, given the extreme rarity of the diagnosis, as well as a lack of familiarity on the part of the radiology community as to the most commonly utilized diagnostic criteria, the diagnosis can often be overlooked.”
    Portal Vein Aneurysms: Imaging Manifestations and Clinical Significance
    Dalal PS, Raman SP, Horton KM, Fishman EK
    Emerg Radiol 2013 May 23 (Epub ahead of print)
  • Portal Vein Pathologies
    - Portal vein aneurysm
    - Portal vein thrombosis
    - Portal venous gas
    - Portosystemic collateral pathways
    - Congenital anomalies of the portal vein
  • “Portal vein aneurysm is an uncommon finding. Two major causes, congenital and acquired, have been proposed. Strong support is given to the theory that they are acquired because a significant number of portal vein aneurysms are detected in patients with underlying hepatocellular disease and portal hypertension. The congenital cause is supported by the fact that some of the portal vein aneurysms are found in children and young adults who have no evidence of liver disease or portal hypertension.”
    Extrahepatic Portal Vein Aneurysms
    Blasbalg R et al.
    AJR March 2000 vol 174
  • “Although aneurysms of the portal venous system may be present in patients with liver disease, an overwhelming majority of patients do not have portal hypertension or chronic liver disease. Therefore, portal hypertension could be contributory but is not essential to the development of portal venous system aneurysms.”
    Congenital and Acquired Anomalies of the Portal Venous System
    Gallego C et al.
    RadioGraphics 2002; 22:141-159
  • “Reasons to favor a congenital origin are the in utero diagnosis of a portal vein aneurysm , evidence of portal venous system aneurysms in patients with histologically proved normal livers , and the frequent stability of the aneurysms at follow-up . Incomplete regression of the distal right vitelline vein leading to a diverticu- lum that would ultimately develop into an aneu- rysm in the proximal superior mesenteric vein could explain aneurysms in that location.”
    Congenital and Acquired Anomalies of the Portal Venous System
    Gallego C et al.
    RadioGraphics 2002; 22:141-159
  • “The most common locations are the splenomesenteric venous confluence, main portal vein, and intrahepatic portal vein branches at bifurcation sites; the rarest locations are the splenic, mesenteric, and umbilical veins.”
    Congenital and Acquired Anomalies of the Portal Venous System
    Gallego C et al.
    RadioGraphics 2002; 22:141-159
  • “Most portal venous system aneurysms are asymptomatic and do not demonstrate a signifi- cant increase in size once discovered, although some manifest with nonspecific abdominal pain as a major symptom.”
    Congenital and Acquired Anomalies of the Portal Venous System
    Gallego C et al.
    RadioGraphics 2002; 22:141-159
  • “Complications of portal ve- nous system aneurysms are abdominal pain; thrombosis; portal hypertension (due to flow alterations or compression of the main portal vein); rupture; thrombosis and distal embolism; compression of the common bile duct causing jaundice, cholestasis, and cholelithiasis; and com- pression of the duodenum.”
    Congenital and Acquired Anomalies of the Portal Venous System
    Gallego C et al.
    RadioGraphics 2002; 22:141-159

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