Aneurysm of the Portal Vein and Portal Hypertension

Hermann, Robert E.; Shafer, William H.

doi:10.1097/00000658-196512000-00022

Cited by 50 publications

(33 citation statements)

References 6 publications

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“…The pathogenesis of PV aneurysms is controversial and it can be congenital or acquired, as a result of weakening of the venous wall. Incomplete regression of the distal right vitelline vein and an inherent weakness of the vessel wall are proposed theories to support a congenital origin (7). Acquired factors may include portal hypertension, chronic hepatic disorder, necrotizing pancreatitis, trauma, and the sequelae of abdominal surgery.…”

Section: Portal Vein Aneurysmsmentioning

confidence: 99%

Cross-sectional imaging of congenital and acquired abnormalities of the portal venous system

Ozbayrak

Tatlı²

2016

Diagn Interv Radiol

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A wide range of congenital and acquired abnormalities may affect the portal venous system. They are sometimes encountered incidentally because of the widespread use of cross-sectional imaging modalities. Awareness of the presence of these abnormalities is important for adequate planning of surgical and percutaneous interventional procedures. The article reviews the normal anatomy, variations, and acquired pathologies involving the portal venous system as showed on computed tomography (CT) and magnetic resonance imaging (MRI). AnatomyThe portal venous system refers to the veins draining the gastrointestinal tract and spleen to the liver, excluding the inferior rectum and anal canal. The superior mesenteric vein (SMV) and splenic vein (SV) behind the neck of the pancreas form the main portal vein (PV) (Fig. 1). The inferior mesenteric vein (IMV) may drain into either the SV or into the confluence directly. The PV divides into the right and left PV. The right PV divides into anterior and posterior branches that supply the right liver lobe. The left PV courses horizontally and branches out to supply the lateral and medial segments of the left lobe (1,2). Congenital abnormalities Variations of the portal veinAnatomic variants of the branching pattern of the intrahepatic PV are present in approximately 20% of the population (1). The most common variant is trifurcation of the PV; the right PV does not exist and the PV divides into the right anterior, right posterior, and left branches (Fig. 2). Right anterior segmental branch arising from the left PV is another common variant (Fig. 3). Less common PV variations have been reported but their incidence has not been found to be higher than 2% (2). Awareness of these variants is crucial for planning surgery; for example, in a patient with right anterior segmental branch arising from the left PV, ligation of the left PV during left hepatectomy may lead to unexpected infarction of the anterior segment of the right liver lobe. Congenital agenesis of the portal veinCongenital agenesis of the PV is a rare malformation characterized by the absence of the PV and anomalous drainage of SMV and SV into the systemic circulation (Fig. 4). The PV is normally formed in 4-10 weeks of embryonic development via involution of the periintestinal vitelline venous loop. Atypical involution may cause a prebiliary, preduodenal, or duplicated PV, and excessive involution may result in the absence of the PV (3). Liver morphology is generally preserved. Congenital agenesis of the major branches of the PV is ABSTRACTKnowing the normal anatomy, variations, congenital and acquired pathologies of the portal venous system are important, especially when planning liver surgery and percutaneous interventional procedures. The portal venous system pathologies can be congenital such as agenesis of portal vein (PV) or can be involved by other hepatic disorders such as cirrhosis and malignancies. In this article, we present normal anatomy, variations, and acquired pathologies involving the portal venous system ...

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Section: Portal Vein Aneurysmsmentioning

confidence: 99%

Cross-sectional imaging of congenital and acquired abnormalities of the portal venous system

Ozbayrak

Tatlı²

2016

Diagn Interv Radiol

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“…A relatively rare lesion, portal vein aneurysms may arise from either the intrahepatic or extrahepatic portion of the portal vein. 13 • 11 On ultrasound, aneurysms will appear as a spherical mass, as a localized saccular dilatation, or as a localized fusiform dilation of the involved vessel. 17 • 1 U 5 • 11 J Ultrasound Med 7;681-685, 1988…”

Section: ·Uumentioning

confidence: 99%

The persistent vitelline vein segment. Embryologic and ultrasound features.

Shawker

Miller

1988

Journal of Ultrasound in Medicine

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Complex developmental changes occur during embryonic life as the vitelline veins evolve into the portal vein. With the increasing use of real-time and Doppler ultrasound, it is not surprising that anomalies of this vessel are being detected. We discovered an unusual tubular outpouching that originated from the extrahepatic portion of the portal vein and extended for 2 em before coming to a blind end. This "blind pouch" was seen by pulsed Doppler ultrasound to communicate freely with the lumen of the portal vein. We believe that this structure represents a persistent embryonic vessel, probably a portion of the vitelline vein system that normally disappears as the portal vein is formed during embryonic life. CASE REPORTA 54-year-old man was admitted with a 6-week history of increasing epigastric pain. He had a past history of type 1 hyperlipidemia, recurrent pancreatitis, and diabetes. Physical examination on admission revealed slight tenderness in the right upper quadrant. His white blood cell count and serum amylase were normal, as were an upper gastrointestinal barium study and upper gastrointestinal endoscopy. An abdominal ultrasound was performed to evaluate the pancreas and gallbladder.Received March 1, 1988, from the Department of Radiology, National Institutes of Health, Bethesda, Maryland, and Georgetown University School of Medicine, Washington, D.C. Revised manuscript accepted for publication May 3, 1988. Address correspondence and reprint requests to Dr. Shawker: Dept. of Radiology, National Institutes of Health, Clinical Center, Bldg 10, Room IC660, Bethesda, MD 20892.The ultrasound examination showed a normal gall bladder and common bile duct. The pancreas was small and of higher than normal echo amplitude, presumably because of fatty replacement and atrophy. A 1.3-cm diameter, tubular fluid-filled outpouching was found arising from that portion of the portal vein immediately to the right of the junction with the superior mesenteric vein (Fig. 1). This vascular outpouching originated from the posterior surface of the portal vein and extended toward the right side of the patient for 2 em before ending blindly. Pulsed Doppler study showed normal hepatopetal flow in the portal vein. In the blind pouch, low velocity bidirectional venous flow was present. The portal vein and portal vein outpouching both changed with respiration, increasing in diameter and showing diminished flow during inspiration. There was also slight narrowing of the splenic vein near its junction with the portal vein. The left gastric vein was not visible; however, the remainder of the portal vein and the superior mesenteric vein were visible and appeared normal.A subsequent celiac arteriogram (Fig. 2) also showed this sac-like extension of the portal vein that arose near the confluence of the superior mesenteric and splenic veins. The outpouching communicated freely with the portal vein. Flow in the portal vein was toward the liver and was noted to be slow. Varices were present in the gastric fundus and there was also mild narrowin...

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“…We reviewed the scientific literature indexed in MEDLINE and LILACS (Latin American and Caribbean literature on Health Sciences) and recorded all descriptions of portal vein aneurysms, which correspond to 53 medical articles since 1965, referring to almost 70 cases up to the present, including English and non-English articles 1,4,7,8,14,15,17,19,21,[23][24][25][26]29,30 Portal aneurysms can be caused by portal hypertension, but have never before been related to hepatosplenic schistosomiasis. We report the finding of an intrahepatic portal vein aneurysm in a patient with hepatosplenic schistosomiasis with a marked reduction in its dimensions after splenectomy.…”

Section: Introductionmentioning

confidence: 99%

Treatment by splenectomy of a portal vein aneurysm in hepatosplenic schistosomiasis

Mucenic

Rocha

Laudanna

et al. 2002

Rev. Inst. Med. trop. S. Paulo

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SUMMARYPortal vein aneurysm is a rare medical entity that can be caused by chronic hepatic diseases with portal hypertension. We describe a 45-year-old man with variceal bleeding from hepatosplenic schistosomiasis and an incidentally found intrahepatic aneurysm. Diagnosis was confirmed with non-invasive imaging exams, arteriography and liver biopsy. Following splenectomy, the aneurysm diameter decreased substantially.

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Aneurysm of the Portal Vein and Portal Hypertension

Cited by 50 publications

References 6 publications

Cross-sectional imaging of congenital and acquired abnormalities of the portal venous system

Cross-sectional imaging of congenital and acquired abnormalities of the portal venous system

The persistent vitelline vein segment. Embryologic and ultrasound features.

Treatment by splenectomy of a portal vein aneurysm in hepatosplenic schistosomiasis

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