Angiographic documentation of systemic-portal venous shunting as a cause of a liver scan ""hot spot'' in superior vena caval obstruction

Lee, KR; Preston, DF; Nl, Martin; Robinson, R.G.

doi:10.2214/ajr.127.4.637

Cited by 29 publications

(14 citation statements)

References 3 publications

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“…Two potential systemic venouscollaterals havebeen postulated to flow into the liver and to cause the hyperperfusion.First, the superficial epigastric vein may anastomose with a small remnant of the umbilical vein and thus drain into the left portal vein [22]. Second, musculophrenic col lateral veins may drain into the right or left lobe @ of the liver through the bare area [27].…”

Section: Resultsmentioning

confidence: 99%

Hepatic and portal surface veins: a new anatomic variant revealed during abdominal CT.

Sheporaitis

Freeny²

1998

American Journal of Roentgenology

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OBJECTIVE. The objectiveof this paper is to describea new finding on CT of hepatic and portal vein segments located in a subcapsular location on the surface of the liver.SUBJECTS AND METHODS. From a seriesof more than I I .000 contrast-enhanced abdominalCT scansperformedfrom 1993 to 1997, 14 patientswere identifiedashavinghe patic or portal vein segments or both in a subcapsular location on the surface of the liver.RESULTS. We found sevenportalvein surfacesegmentsin sevenpatientsand 14 hepatic vein surface segments in 12 patients. Ufthe 14 patients, five had both portal and hepatic vein surface segments. Therefore, in a cohort that exceeded 11,000 patients, the incidence of this finding was 0.1%. Four patients had cirrhosis, two had small hypervascular liver lesions, and eighthadhealthylivers.The surfaceveinswere not associated with any otherrecognizedvas cular anomalies or with anastomoses to extrahepatic systemic veins.CONCLUSION. Hepaticandportalveinscancourseto a subcapsular locationon the sur faceof theliver.Thisanatomyisbelievedto bea normalvariantandcanbefoundin patientswith healthyliversandnormalhepaticveinhemodynamics andin patientswith portalhypertension. T his paper describes a new vascularanatomic variant observed on CT:hepaticand portal veinscoursing in a subcapsular location and protruding from the surface of the liver. To our knowledge, this finding has not been reported previously in the radiology or anatomy literature. Subjects and MethodsThe findingofan enlargedhepaticveinextending to and protruding from the surface of the liver was first recognized on CT at our institution in October 1993. Abdominal CT was performed with a HiSpeedAdvantage helical scanner (General Electric Medical Systems, Milwaukee, WI) with 3-to 5-mm collima flon,helical technique, andvariable pitchto image the entire liver in a single breath-hold. Two protocols were used for contrast enhancement. Single-phase (portal venous phase) helical scanning was per formedusinga SmartPrep(GeneralElectricMedical Systems) scan delay with a hepatic threshold of 50â€" 70 H duringIV powerinjectionof 150-200 ml of ioversol (320 mg I/ml) at 3â€"5 mI/sec. Dual-phase helical scanning (arterial and portal venous phases) was performed using an initial test bolus of 20 ml of ioversoladministeredthroughan 18-to 19-gaugean tecubitalvein at a rate of 5 mI/secusing a power in jector. During the test bolus. low-dose axial scans were obtained at the level ofthe celiac artery (the Tl2 vertebra). Using scanner software, a cursor was placedon the aorta,and time to peak aorticenhance mentwas calculatedand displayedgraphically. A bo lus of 180ml of ioversol was then power-injectedat 5 mI/sec.Arterialphase imagingwas initiatedeitherat time to aortic peak plus 5 sec or at time to aortic peak minus 2 sec, and portal venous phase imaging was initiated60 sec afterthe startof the administrationof the bolus of contrast material.Arterial phase scans were initiated at peak minus 2 sec specifically for ac quiring axial images for three-dimensional (3D) CT angiograph...

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Section: Resultsmentioning

confidence: 99%

Hepatic and portal surface veins: a new anatomic variant revealed during abdominal CT.

Sheporaitis

Freeny²

1998

American Journal of Roentgenology

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“…A focal area of increased radiotracer uptake (''hot spot'') between the right and left lobe, secondary to SVC obstruction, on 99m Tc MAA (macroaggregated albumin) scan has also been described [9]. One possible explanation for this phenomenon is diversion of blood to the periumbilical veins and the left portal vein along the ligamentum teres via superficial thoracoabdominal and epigastric veins [1,2]. The hot spot is simply a well-localized abnormal blood flow phenomenon of collateral channels unrelated to any intrinsic liver diseases [4].…”

Section: Discussionmentioning

confidence: 99%

“…It is characteristically located on the anterior inferior aspect of the quadrate lobe of the liver, near the portal area, at the junction of the right and left lobes [4]. A liver hot spot seems to occur when there is considerable systemic-portal venous flow through the anterior parietal and periumbilical venous channels, suggesting that the major deep collateral flow through the azygos ascending lumbar pathway is less well developed [2]. Thus, obstruction of the azygos-atrium junction might induce development of systemic-portal collateral pathways and enhancement of the lateral segment of the left lobe as in our patient.…”

Section: Discussionmentioning

confidence: 99%

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Focal Enhanced Areas of the Liver on Computed Tomography in a Patient with Superior Vena Cava Obstruction

Baba

Ohkubo

Nakai

et al. 1999

Cardiovasc Intervent Radiol

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“…Areas of pseudolesions and focal fatty infiltrations in this area can vary with the blood supply from these small The inferior veins of Sappey descend along the falciform ligament and connect with the epigastric veins superiorly and/or inferiorly. Such pathways can become collateral pathways in cases of superior or inferior vena cava obstruction [13,14,15]. Areas of focal contrast enhancement of the liver on early-phase CT may be seen around the falciform ligament (Fig.…”

Section: Introductionmentioning

confidence: 99%

Small veins entering the liver

et al. 2002

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It is important to recognize and understand focal fatty infiltration and pseudolesions of the liver mimicking liver tumors on CT during arterial portography or helical-CT images. These conditions are caused by venous flow outside the main portal vein. Unless this is borne in mind, incorrect diagnosis and management may follow. This article demonstrates the appearance of the parenchymal changes caused by systemic venous flow and location of the systemic veins entering the liver parenchyma.

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Angiographic documentation of systemic-portal venous shunting as a cause of a liver scan ""hot spot'' in superior vena caval obstruction

Cited by 29 publications

References 3 publications

Hepatic and portal surface veins: a new anatomic variant revealed during abdominal CT.

Hepatic and portal surface veins: a new anatomic variant revealed during abdominal CT.

Focal Enhanced Areas of the Liver on Computed Tomography in a Patient with Superior Vena Cava Obstruction

Small veins entering the liver

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