Imaging features of non-traumatic vascular liver emergencies

Abstract

Acute non-traumatic liver disorders can originate from abnormalities of the hepatic artery, portal vein and hepatic veins. Ultrasonography and computed tomography can be used in non-traumatic acute vascular liver disorders according to patient status, indication and appropriateness of imaging modality. Awareness of the imaging findings, in the appropriate clinical context, is crucial for prompt and correct diagnosis, as delay may cause severe consequences with significant morbidity and mortality. This review article will discuss imaging algorithms, and multimodality imaging findings for suspected acute vascular disorders of the liver.

Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview

“…CT is commonly used for diagnosis and usually shows the absence/ presence of enhancement within the thrombus, which is critical for characterising the thrombus (Figure 1A ). Acute thrombosis is usually hyperdense on pre-contrast CT images, whereas chronic thrombosis can lead to calcifications in the portal vein and abnormal liver perfusion areas can be detected in the liver parenchyma, especially in the arterial phase[ 11 , 12 ]. A decrease in portal vein flow may be caused by portal vein or hepatic vein thrombosis, compression by focal masses such as abscesses, long-standing biliary obstruction, or parenchymal trauma.…”

Interventional Radiology Options after Visceral Surgery

“…Early bleeding within 48 h after surgery can usually be managed by re-operation, and interventional treatment can address delayed bleeding (e.g., due to arterial erosion). In most cases, bleeding is delayed and results from accompanied anastomosis leakage or postsurgical infectious collections, which destruct the arterial wall [29]. In more than half of the cases, bleeding is either from pancreatic anastomosis or splanchnic arteries [26].…”

“…Early thrombosis is usually related to surgical technique and should be managed with prompt surgical correction or with re-transplantation. The clinical presentation can range from delayed bile leaks, perihepatic fluid collections, sepsis, to acute fulminant hepatic failure [29]. In patients with hepatic arterial thrombosis, selective catheterization of the hepatic arterial stump with a microcatheter and infusion of thrombolytics can restore the flow, and balloon dilatation and stenting should follow in case of underlying stenosis [42].…”

Role of Imaging in the Study of Vascular Disorders of the Liver

“…Hepatic artery dissection is rare and favored by surgical or radiologic interventions. On contrast enhanced CT or MRI, the hepatic artery is enlarged with a linear low-attenuated filling defect within the lumen [43].…”

“…Portal vein aneurysms are uncommon and account for only 3% of all venous aneurysms [43]. They may be congenital or acquired, cirrhosis, trauma, portal hypertension, surgery, and pancreatitis being the most common causes.…”