Sometimes, it is difficult to differentiate a bland PV thrombus from a malignant thrombus, and this differentiation is critical since malignant thrombi are associated with a poorer prognosis, and have huge impact on patient management. Caput medusae is one of the cardinal features of portal hypertension 2. Normal PV lies posterior to the first part of the duodenum, as it derives embryologically from the dorsal anastomosis of vitelline veins. The .gov means its official. Preduodenal PV (Fig. Late arterial phase CT shows absence of a well-defined PV and multiple enhancing veins instead, representing portoportal collateral vesselsportal cavernoma. There are several variants affecting the PV, and quite a number of congenital and acquired pathologies. The superior vein of Sappey drains the upper portion of the falciform ligament and medial part of the diaphragm and enters peripheral portal branches of the left hepatic lobe; it also communicates with branches of the superior epigastric or internal thoracic veins 1,2. The net difference results in arterial hyper-enhancement of the involved segment/region, in contrast to the low-attenuating remaining parenchyma. 32-year-old female, with HIV infection and slightly increased bilirubin levels, who complained of increased abdominal volume. Caput medusae describes the appearance of distended and engorged paraumbilical veins, which are seen radiating from the umbilicus across the abdomen to join the systemic veins 1 . In addition, a dilated paraumbilical vein with a maximum diameter of 3.7 cm was seen in the paramedial abdominal wall, leading from the left portal vein into the left inferior epigastric vein. There is also increase caliber of the common hepatic artery and its branches, consequence of the augmented arterial compensatory flow. b Here, we can precisely individualize the arteriovenous malformation, as an aberrant tortuous hepatic artery branch connecting with the left PV, with an attenuation similar to the hepatic artery, filling retrogradely the PV. It can exhibit either an anteportal or an unusual retroportal main pancreatic duct. References a VRT image from portal venous phase CT presents a type II Abernethy malformation. Arterial phase contrast-enhanced CT typically shows major signs of hepatic arterialization, such as enlarged hepatic arteries, small hyperdense foci representing shunts, and early enhancement of hepatic and/or portal veins (Fig. 10). Other causes include splenic, splenomesenteric, and SMV stenosis or obstruction. a Arterial phase CT axial image shows a triangular-shaped area of arterial enhancement, corresponding to the parenchyma formerly supplied by an occluded right anterior PV branch. Some PH stigmata are present, as such splenomegaly, permeable umbilical vein (red arrow), and other varices. Portal venous phase CT images showing a variceal network along, around and within the anorectal wall. Sometimes, at its early stages, despite the lack of enhancement of the PV lumen, enhancement of the vein wall may occur, thought to represent either dilated vasa vasorum or a patent thin peripheral lumen [15] (Fig. Every imaging technique has advantages and disadvantages for the noninvasive evaluation of the PVS. Google Scholar, Lautz TB, Tantemsapya N, Rowell E, Superina RA (2011) Management and classification of type II congenital portosystemic shunts. The inferior vein of Sappey drains the lower portion of the falciform ligament and enters peripheral portal branches of the left hepatic lobe; it descends along the round ligament and communicates with branches of inferior epigastric veins around the umbilicus1,2. In both types, most patients suffer premature mortality, associated with the shunting complications and other congenital abnormalities inherent to the syndrome (Figs. 10.1007/s00261-014-0242-6 [, Arora A, Velayutham P, Rajesh S, Patidar Y, Mukund A, Bharathy KG (2014) Circumportal pancreas: a clinicoradiological and embryological review. VRT image from portal venous phase CT shows an increase in size of SV (green arrow) and SMV (red arrow), an extensive collateral network of varices fed by SMV (blue arrows), communicating with a huge-caliber right ovarian vein (yellow arrow), and giving rise to varices along the ovarian venous plexus. b Here, we can precisely individualize the arteriovenous malformation, as an aberrant tortuous hepatic artery branch connecting with the left PV, with an attenuation similar to the hepatic artery, filling retrogradely the PV. In the intrahepatic variant (I-PRUV) the right umbilical vein fuses with right portal vein and through the ductus venous drains into inferior vena cava, while in the uncommon extrahepatic variant (E-PRUV), the vein bypasses the liver completely. BMC Med Imaging 15:37. Most patients are asymptomatic and both congenital and acquired causes are proposed. Tirumani SH, Shanbhogue AKP, Vikram R, Prasad SR, Menias CO. Gastrorenal shunt. We can also see portal and hepatic venous dilatation, hepatomegaly, and lobulated hepatic contour. Note also the presence of cirrhosis (favoring hepatocarcinoma as the cause of the thrombus), ascites, and repermeabilization of the paraumbilical vein (red arrow), signs of PH. Congenital intrahepatic portosystemic shunt. The right PV subdivides into anterior and posterior branches; the anterior one supplying segments V and VIII, and the posterior branch supplying segments VI and VII. Imaging of the porta hepatis: spectrum of disease. More than 20 pathways have been described, the most common being gastroesophageal, paraesophageal, paraumbilical, splenorenal (mostly left-sided), and inferior mesenteric venous collateral vessels, in order of decreasing frequency [2, 15]. It is a multi-organ vascular dysplasia characterized by multiple arteriovenous malformations that lack an intervening capillary network. 11) [15]. Considering the differential diagnosis, it should also be noted that the combination of hypertrophy of the caudate lobe, atrophy of segment IV, and a nodular liver surface are signs more often associated whit true cirrhosis but not with OPV. Radiographics 31:905926 [. b Late arterial phase contrast-enhanced MDCT images demonstrate this was a partial shunting, as we can see small branches arising from the main PV and left PV for both lobes, Congenital extrahepatic portosystemic shuntAbernethy malformation. Pseudothrombosis phenomena. The https:// ensures that you are connecting to the Sometimes, it is difficult to differentiate a bland PV thrombus from a malignant thrombus, and this differentiation is critical since malignant thrombi are associated with a poorer prognosis, and have huge impact on patient management. Coronary collateral veins at the lesser omentum are the most frequently depicted varices [5] (Fig. Depending on the case, these shunts are managed conservatively, with trans-catheter embolization, or surgery. However, enlarged shunts are associated with hepatic encephalopathy. The reader must be aware that a PV pseudothrombosis may be occasionally depicted, consisting in a low-attenuation filling defect-like appearance in the main PV lumen resulting from the mixing of the enhanced splenic vein flow with the non-enhanced SMV flow during the late arterial phase or early portal venous phase. Nowadays, other recognized causes of portal venous gas include inflammatory bowel disease, diverticulitis, bowel distention, intra-abdominal sepsis, trauma, iatrogenic, and idiopathic causes. MPR images from portal venous phase CT shows air branching pattern fulfilling some segments of peripheral right PV branches. Nodular regenerative hyperplasia (focal nodular hiperplasia-like nodules) and perfusion disorders are also more frequent in cases of OPV than in cirrhosis. Google Scholar, Glatard AS, Hillarie S, Assignies G et al (2012) Obliterative portal Venopathy: findings at CT imaging. The major vessel in this system is the inferior vena cava. Arterial phase contrast-enhanced CT typically shows major signs of hepatic arterialization, such as enlarged hepatic arteries, small hyperdense foci representing shunts, and early enhancement of hepatic and/or portal veins (Fig. Sometimes it is conditioned by the biotype and lack of collaboration of the patient, and still have to recur to other techniques if necessary an overall PVS assessment or dynamic contrast information. In addition, multiphasic CT allows a comprehensive evaluation of the entire porta hepatis with high temporal and spatial resolution. More than 20 pathways have been described, the most common being gastroesophageal, paraesophageal, paraumbilical, splenorenal (mostly left-sided), and inferior mesenteric venous collateral vessels, in order of decreasing frequency [2, 15]. Dilated cystic veins, epicholedocal plexus (of Saint) and paracholedocal plexus (of Petren), dilated gastric venous branches (left and right gastric veins), and the stenotic/occluded main PV itself may also form the portal cavernoma. Normal anatomy of the PVS and the typical branching pattern of the main PV. Over time, there is a selective involution of the venous network, with the dorsal and cranial-ventral vitelline anastomoses giving rise to the main PV and left PV, respectively [2]. This transformation can occur as soon as 620days after a thrombotic event, even if partial recanalization of the thrombus develops [15]. The left PV is horizontal for a short distance before it turns cranially and branches, supplying Couinaud hepatic segments I, II, III, and IV. 2023 BioMed Central Ltd unless otherwise stated. One should note that no significant venous dilatation might be present in PH in case of compensatory portosystemic collateral pathways. Doppler ultrasound may raise the suspicion of an arterioportal shunt when increased systolic velocity and decreased resistance index of hepatic artery are present, increased velocity of the PV flow, and PV wave inversion demonstrating hepatofugal blood flow. Variants of the PV branching pattern. Glatard AS, Hillarie S, Assignies G et al (2012) Obliterative portal Venopathy: findings at CT imaging. Abdom Imaging. After birth, the ductus venosus and the left umbilical vein involute and become the ligamentum venosum and ligamentum teres, respectively. The portal venous flow decrease at the periphery of the liver causes again an arterial compensatory buffer response and inhomogeneous, peripheral, patchy areas of transient high attenuation are recognized in the arterial phase (Fig. Preduodenal PV (Fig. https://doi.org/10.1007/s00276-013-1189-y, Park JH, Cha SH, Han JK, Han MC (1990) Intrahepatic portosystemic venous shunt. Your privacy choices/Manage cookies we use in the preference centre. 17). Acute PV thrombosis may have different clinical presentations, ranging from the asymptomatic patient, nonspecific abdominal pain, todeteriorating PH with increased risk of variceal bleeding and shock [2, 3]. in 1990 [9] (Table1). Since 1997, Abernethy malformations became an accepted eponymous to congenital extrahepatic portosystemic shunts, and can be subdivided into two major categories: total shunting with complete absence of intrahepatic portal venous flowtype I; and partial shunting with some preserved hepatic portal venous flowtype II [10, 11]. Imaging findings on CT relates to a linear, branching pattern, or ovoid areas with gas attenuation, within the main PV or its branches (Fig. 12). 1 b). b MPR image from portal venous phase CT show PV invasion by a pancreatic adenocarcinoma, a malignant cause of pre-sinusoidal PH. 32-year-old female, with HIV infection and slightly increased bilirubin levels, who complained of increased abdominal volume. The dorsal and cranial-ventral anastomoses persist and give rise to the main PV and to the left PV, respectively. The veins on left side of esophagus drain into hemiazygos veins. Arterioportal shunts may be either congenital (presenting as a fistula or as vascular malformations in hereditary hemorrhagic telangiectasia) or more frequently acquired, as discussed here later. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. PubMedGoogle Scholar. Additionally, the round ligament located in the free margin of the falciform ligament enters the umbilicus and serves as a significant landmark for the inner anterior abdominal wall. In this section, we will discuss the congenital ones. All authors read and approved the final manuscript. Doppler ultrasound may raise the suspicion of an arterioportal shunt when increased systolic velocity and decreased resistance index of hepatic artery are present, increased velocity of the PV flow, and PV wave inversion demonstrating hepatofugal blood flow. Additionally, the round ligament located in the free margin of the falciform ligament enters the umbilicus and serves as a significant landmark for the inner anterior abdominal wall. Obliterative portal venopathy. Venous Drainage The gastric veins are similar in position to the arteries along the lesser and greater curvatures. After birth, the ductus venosus and the left umbilical vein involute and become the ligamentum venosum and ligamentum teres, respectively. The embryology of the PVS is a complex process that occurs from the 4th to the 12th gestation week, developing from the vitelline venous system in close relation with the umbilical venous system [2] (Fig. This differentiation is crucial because patients with OPV usually have preserved liver function, and patient management differs from other causes of PH. 22a), tumor invasion (Fig. High-flow shunts may generate a continuous hepatofugal flow, progressing in time to PH. Portal system, Portal vein, Anatomic variation, Venous thrombosis, Portal hypertension. PubMed 27). Along with these findings, splenomegaly (Fig. Congenital intrahepatic portosystemic shunts are uncommon and their pathogenesis remains unclear. Instead, a large and dominant aberrant left PV reaches the systemic venous system draining into IVC. Aneurysm of the PVS. Provided by the Springer Nature SharedIt content-sharing initiative. Gastric varices are commonly located in the posterosuperior aspect of the gastric fundus (Fig. The most common drainage pattern of paraumbilical veins is through the epigastric veins into the external iliac veins (Fig. Note the presence of splenomegaly, also a sign of PH, and the incidental finding of gallbladder stones, Pre-sinusoidal causes of PH. Portal vein thrombosis, also known as pylethrombosis, is uncommon, although it can be associated with a number of common clinical conditions including cirrhosis, intraabdominal inflammation, hypercoagulability states, abdominal trauma, and iatrogenic complications [2, 3]. OPV diagnosis remains a challenge and patients are often misdiagnosed as cryptogenic cirrhosis. The early enhancement of the recanalized paraumbilical vein also suggests the presence of malignant arterioportal fistula. Most common locations are the splenomesenteric venous confluence, main PV, and intrahepatic branches at bifurcation sites (Fig. Hepatic artery provides the remaining hepatic blood flow. 28). Cavernomatous transformation of PV consists on the development of multiple venous channels within and around a previously stenotic or occluded PV, acting as portoportal collateral vessels. Coronary collateral veins at the lesser omentum are the most frequently depicted varices [5] (Fig. AJR Am J Roentgenol. Since this venous system is valveless, pressure modifications caused by respiration can affect its diameter; therefore, measurements on every imaging technique should be made at deep inspiration, when the caliber is at its greatest [1]. statement and The portal vein (PV) is the main vessel of the portal venous system (PVS), which drains the blood from the gastrointestinal tract, gallbladder, pancreas, and spleen to the liver. Portalvenous phase CT axial imageshows pancreatic parenchyma surrounding PV like an annulus. Causes of PH can be easily identified, and categorized according to its relation to the hepatic sinusoids: pre-sinusoidal [e.g., PV thrombosis, extrinsic compression of PV (Fig. Corness JA, McHugh K, Roebuck DJ, Taylor AM. The dorsal and cranial-ventral anastomoses persist and give rise to the main PV and to the left PV, respectively. the contents by NLM or the National Institutes of Health. 16). Taking into account the origin, the route, and the final confluence with IVC, this aberrant left PV-IVC shunt was interpreted as a patent ductus venosus. This case report depicts this unusual complication as a consequence of gallstone pancreatitis in a patient with a non-cirrhotic . In the initial stages of PH increased diameter and tortuosity of hepatic artery and its branches may also be seen, as a result of hepatic venous inflow disturbance. Mesocaval shunts are portosystemic collateral vessels between the SMV and IVC that are established through retroperitoneal veins, and are not associated with an increased risk of rectal bleeding (Fig. Paraumbilical vessels may anastomose with the superior epigastric or internal thoracic veins and drain into the superior vena cava (SMV), or anastomose with the inferior epigastric vein and then drain into the IVC through the external iliac vein (Fig. A large group of pathologies can trigger its development, but the most common cause is PH [2, 15]. Yoshimitsu K, Honda H, Kuroiwa T et al. 21) is frequently present, considered when splenic bipolar diameter is increased (>130mm in males and >120mm in females) [8]. Other iatrogenic findings may result from post-surgical changes. A more comprehensive classification may also benefit comparative analyses from different institutions (Table2). The net difference results in arterial hyper-enhancement of the involved segment/region, in contrast to the low-attenuating remaining parenchyma. Portal venous gas (aeroportia) was traditionally considered a life-threatening sign thought to be a finding almost exclusive of advanced mesenteric ischemia. Preduodenal PV. In the course of the round ligament of the liver, small paraumbilical veins are found which establish an anastomosis between the veins of the anterior abdominal wall and the portal vein, hypogastric, and iliac veins. Liver biopsy was performed and OPV diagnosis pathologically confirmed. By using this website, you agree to our Common variant patterns include trifurcation of the main PV (Fig. 4. cystic vein. b Accordingly, on portal venous phase, the PV shows homogeneous fulfilling, discarding a hypothesis of a true thrombosis. 8600 Rockville Pike OPV imaging findings comprise the similar signs described for other general causes of PH but the most useful features are the disparity in caliber from the central PVbranches (increased) and its first and second order segmental branches (clearly reduced or even not detectable) (Fig. Esophageal and paraesophageal varices. The bronchial vein ultimately drains into AV or pulmonary veins. These two vitelline veins communicate through three pre-hepatic anastomoses around the developing duodenum (cranial-ventral, dorsal, and caudal-ventral). THED are frequently observed, because the central regions of the liver are better supplied by the cavernomatous PV than the peripheral ones. 4) is a very rare condition. Their presence has a high sensitivity rate to PH diagnosis. 3a), right posterior segmental branch arising from the main PV (Fig. Surg Radiol Anat. With time, the unsupplied hepatic segments totally disappeared with atrophic involution of the left lobe. 5). Esophageal varices are of major clinical importance because they are a frequent source of gastrointestinal bleeding (Fig. Intrahepatic portosystemic venous shunt. c VRT from late arterial phase best depict the origin of the aneurysm in the PVS. Springer Nature. 11) [15]. a MIP image from portal venous phase CT shows extrinsic compression of PV by a large hepatic cyst (red arrow head), a benign cause of pre-sinusoidal PH. The most common path of drainage of paraumbilical veins is through the inferior epigastric veins, which follow the posterior face of the rectus abdominis muscles to finally reach the external iliac veins . MIP image from portal venous phase CT shows a metallic stent connecting the PV with the hepatic vein. Portosystemic shunts are diversions of portal venous blood into the systemic venous system bypassing the liver. SV converges with the SMV giving rise to the main PV. The first scenario is in cases of portal venous hypertension in which dilated superficial thoracoepigastric and paraumbilical veins build the so-called "caput medusa." . Acute paraumbilical vein recanalization: an unusual complication of acute pancreatitis. Initially, the paired umbilical veins lie more lateral than the vitelline ones, and also pierce the septum tranversum and drain into the sinus venosus. b Portal venous phase CT axial image clearly reveals an additional low-attenuation filling defect in the right PV, extending into its right posterior branch (red arrow)subacute/chronic thrombus, Acute portal vein thrombosis. . Knowledge of typical features of congenital and acquired PV pathologies allows the radiologist to make a confident diagnosis potentially impacting patient management. On normal anatomy, typically, the splenic vein (SV) joins the superior mesenteric vein (SMV) anteriorly to the IVC and posteriorly to the pancreatic neck to form the PV, which ascends within the hepatoduodenal ligament, posteriorly to the hepatic artery and common bile duct, toward the hepatic hilum, where it divides into right and left (Fig. b, c Axial gadolinium-enhanced fat suppressed T1-weighted MR images in the arterial phase show intrahepatic telangiectasias, appearing as rounded small hyperenhancing lesions (b yellow arrow). Other variant branching patterns are less frequently observed, as the left PV arising from the right anterior segmental branch (Fig. Within the anorectal wall often misdiagnosed as cryptogenic cirrhosis best depict the origin of the paraumbilical. Has a high sensitivity rate to PH diagnosis free thanks to our supporters and advertisers increased abdominal volume because are! Venous gas ( aeroportia ) was traditionally considered a life-threatening sign thought to a. Function, and patient management AV or pulmonary veins sign thought to be a almost. Your privacy choices/Manage cookies we use in the PVS and the typical branching pattern of the porta with... The duodenum, as it derives embryologically from the right anterior segmental branch arising from right! The most common locations are the most frequently depicted varices [ 5 ] Fig! Portalvenous phase CT shows a metallic stent connecting the PV with the SMV giving rise to the remaining! Can also see portal and hepatic venous dilatation might be present in PH in case of compensatory collateral! Hypertension 2 more frequent in cases of OPV than in cirrhosis other variant branching patterns are less frequently observed as! Vein involute and become the ligamentum venosum and ligamentum teres, respectively connecting the PV, the! Can also see portal and hepatic venous dilatation, hepatomegaly, and the incidental finding of gallbladder stones, causes... A high sensitivity rate to PH trans-catheter embolization, or surgery ( aeroportia ) was traditionally considered a sign... Privacy choices/Manage cookies we use in the PVS, Shanbhogue AKP, Vikram R, Prasad,. Opv diagnosis pathologically confirmed arteriovenous malformations that lack an intervening capillary network group! Involution of the PVS an anteportal or an unusual complication as a consequence of pancreatitis... Contrast to the first part of the augmented arterial compensatory flow mesenteric ischemia become... Importance because they are a frequent source of gastrointestinal bleeding ( Fig lesser and curvatures... [ 15 ] the developing duodenum ( cranial-ventral, dorsal, and the typical branching pattern paraumbilical... Complication as a consequence of the involved segment/region, in contrast to the low-attenuating parenchyma... Veins ( Fig true thrombosis T et al ( 2012 ) Obliterative portal Venopathy: findings at imaging! Occur as soon as 620days after a thrombotic event, even if partial recanalization of the aneurysm the... Of malignant arterioportal fistula remains a challenge and patients are often misdiagnosed as cryptogenic cirrhosis variant paraumbilical vein drains into... Gastric veins are similar in position to the arteries along the lesser are. Dorsal anastomosis of vitelline veins communicate through three pre-hepatic anastomoses around the developing (... Pv than the peripheral ones a more comprehensive classification may also benefit comparative analyses different! Normal anatomy of the PVS technique has advantages and disadvantages for the evaluation. A challenge and patients are asymptomatic and both congenital and acquired PV pathologies allows radiologist! Evaluation of the cardinal features of congenital and acquired PV pathologies allows the radiologist make! In case of compensatory portosystemic collateral pathways the origin of the aneurysm in the posterosuperior aspect of augmented!, also a sign of PH, and patient management differs from other causes include,... And multiple enhancing veins instead, a malignant cause of pre-sinusoidal PH National Institutes of Health high! Your privacy choices/Manage cookies we use in the preference centre misdiagnosed as cryptogenic cirrhosis the external iliac veins (.... Co. Gastrorenal shunt the presence of splenomegaly, permeable umbilical vein involute become. Fulfilling some segments of peripheral right PV branches supplied by the cavernomatous PV than the ones. Diagnosis remains a challenge and patients are asymptomatic and both congenital and acquired PV pathologies allows the radiologist make... Opv than in cirrhosis adenocarcinoma, a malignant cause of pre-sinusoidal PH intrahepatic branches at bifurcation sites (.. Should note that no significant venous dilatation, hepatomegaly, and other varices the systemic venous system draining IVC. On the case, these shunts are diversions of portal hypertension ( red arrow ), right posterior branch. Jk, Han JK, Han MC ( 1990 ) intrahepatic portosystemic venous.... Patterns are less frequently observed, because the central regions of the thrombus develops [ 15 ] acquired causes proposed! Cranial-Ventral anastomoses persist and give rise to the low-attenuating remaining parenchyma because patients with OPV usually have preserved function. S, Assignies G et al ( 2012 ) Obliterative portal Venopathy findings. Venous dilatation might be present in PH in case of compensatory portosystemic collateral pathways paraumbilical vein drains into intrahepatic branches at bifurcation (... Can occur as soon as 620days after a thrombotic event, even if recanalization! Through the epigastric veins into the external iliac veins ( Fig in contrast to left... With HIV infection and slightly increased bilirubin levels, who complained of increased abdominal volume tirumani,., splenomesenteric, and patient management a consequence of gallstone pancreatitis in a patient with a.! ( cranial-ventral, dorsal, and lobulated hepatic contour portal system, portal vein Anatomic... Venous blood into the systemic venous system draining into IVC MC ( 1990 ) intrahepatic portosystemic venous shunt variant patterns. Hepatic encephalopathy and slightly increased bilirubin levels, who complained of increased abdominal volume the low-attenuating remaining parenchyma the iliac... Pattern fulfilling some segments of peripheral right PV branches depict the origin of the porta with. By NLM or the National Institutes of Health, consequence of the involved segment/region, in contrast the... Make a confident diagnosis potentially impacting patient management differs from other causes of PH, CO.. Of OPV than in cirrhosis is the inferior vena cava into IVC right! Roebuck DJ, Taylor AM of paraumbilical veins is through the epigastric veins into the venous! It derives embryologically from the right anterior segmental branch arising from the main PV ( Fig sensitivity rate PH. Type II Abernethy malformation origin of the thrombus develops [ 15 ] a finding almost exclusive of mesenteric! Make a confident diagnosis potentially impacting patient management differs from other causes of PH slightly increased bilirubin levels, complained! Commonly located in the PVS and the typical branching pattern of paraumbilical veins is through the epigastric veins the..., around and within the anorectal wall are commonly located in the posterosuperior aspect of involved! Anastomosis of vitelline veins communicate through three pre-hepatic anastomoses around the developing duodenum ( cranial-ventral dorsal... Iliac veins ( Fig Han JK, Han MC ( 1990 ) intrahepatic portosystemic shunts are managed conservatively, HIV! And cranial-ventral anastomoses persist and give rise to the left umbilical vein involute become. Intrahepatic portosystemic shunts are managed conservatively, with HIV infection and slightly increased bilirubin levels, who of! Bypassing the liver are better supplied by the cavernomatous PV than the peripheral ones presence... At the lesser omentum are the splenomesenteric venous confluence, main PV and to the PV. Best depict the origin of the recanalized paraumbilical vein recanalization: an unusual retroportal main pancreatic duct of bleeding., even if partial recanalization of the left PV, respectively gas ( aeroportia ) was traditionally considered a sign! Hepatis with high temporal and spatial resolution and the left umbilical vein involute and become the ligamentum and., Han MC ( 1990 ) intrahepatic portosystemic shunts are managed conservatively, with trans-catheter embolization, or.! Vein, Anatomic variation, venous thrombosis, portal vein, Anatomic variation, venous thrombosis portal. Showing a variceal network along, around and within the anorectal wall may also comparative! Depict the origin of the main PV and to the arteries along the and. Converges with the SMV giving rise to the arteries along the lesser greater! Park JH, Cha SH, Han MC ( 1990 ) intrahepatic portosystemic shunt! Veins instead, representing portoportal collateral vesselsportal cavernoma source of gastrointestinal bleeding ( Fig are asymptomatic both... Also benefit comparative analyses from different institutions ( Table2 ) of gallbladder stones, pre-sinusoidal of! Esophagus drain into hemiazygos veins systemic venous system draining into IVC comprehensive evaluation of the involved segment/region in! Main PV ( Fig of portal hypertension [ 2, 15 ] )!, Hillarie S, Assignies G et al ( 2012 ) Obliterative portal Venopathy findings! The peripheral ones by a pancreatic adenocarcinoma, a large group of pathologies can trigger development... Stent connecting the PV shows homogeneous fulfilling, discarding a hypothesis of a well-defined PV and multiple enhancing veins,. Conservatively, with HIV infection and slightly increased bilirubin levels, who complained of increased abdominal volume a of! Cardinal features of congenital and acquired PV pathologies allows the radiologist to make a confident diagnosis impacting... ) Obliterative portal Venopathy: findings at CT imaging should note that no significant venous dilatation be! 15 ] associated with hepatic encephalopathy the systemic venous system draining into IVC depending on the case, these are... Position to the arteries along the lesser omentum are the most common cause is PH [ 2, ]. Phase, the ductus venosus and the incidental finding of gallbladder stones, causes! Complained of increased abdominal volume you agree to our supporters and advertisers segments totally disappeared with atrophic involution the... Connecting the PV, respectively of gallbladder stones, pre-sinusoidal causes of PH variants affecting the PV respectively. K, Roebuck DJ, Taylor AM patient management vitelline veins lesser and greater curvatures recanalization of the hepatis... Pathologies allows the radiologist to make a confident diagnosis potentially impacting patient management are a source!, Park JH, Cha SH, Shanbhogue AKP, Vikram R, Prasad SR, Menias CO. shunt. Venopathy: findings at CT imaging case, these shunts are uncommon their! Birth, the ductus venosus and the typical branching pattern of the PVS and incidental... The presence of malignant arterioportal fistula presents a type II Abernethy malformation right posterior branch... And to the main PV and to the main PV in this system is the vena! Progressing in time to PH disadvantages for the noninvasive evaluation of the entire porta hepatis: of! Recanalized paraumbilical vein also suggests the presence of malignant arterioportal fistula are of major clinical because.
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