Periportal lymphatic distension resulting from cardiac tamponade: CT findings and clinical-pathologic correlation

Rotondò, Antonio; Scialpi, Michele; Catalano, Orlando; Strada, A.; Grassi, Roberto; Angelelli, Giuseppe

doi:10.1007/s101400050032

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…Some of the reported CT findings in tamponade include enlargement of the superior vena cava with a diameter similar to or greater than that of the adjacent thoracic aorta (Fig 7), enlargement of the IVC with a diameter greater than twice that of the adjacent abdominal aorta (Fig 8), periportal lymphedema (Fig 9), reflux of contrast material within the IVC (Fig 10), reflux of contrast material within the azygos vein, and enlargement of hepatic and renal veins (10,(30)(31)(32)(33)(34).…”

Section: Page 1598mentioning

confidence: 98%

“…Unfortunately these findings seen individually are not specific for tamponade, but the constellation of findings should strongly suggest the diagnosis, particularly in the presence of a large pericardial effusion. For example, periportal lymphatic distention or lymphedema has been described not only in cardiac tamponade but also in patients with chronic congestive heart failure, blunt abdominal trauma with or without liver injuries, cirrhosis, hepatitis, liver transplants, and hepatic or retroperitoneal malignancies (34,35). Similarly, reflux of contrast material into the IVC occurs not only in the setting of cardiac tamponade but can be seen in individuals with intrinsic cardiac disease such as tricuspid regurgitation, patients with hypovolemic or cardiogenic shock, and those with pulmonary embolism, among others (32,33,36).…”

Section: Computed Tomographymentioning

confidence: 99%

“…Lung cancer can result in tamponade via metastatic pericardial or cardiac involvement (60). Aortic pathologic conditions that can result in tamponade include aortic dissection and aneurysm rupture (34,61,62) (Fig 22). Mediastinal pathologic conditions that can cause tamponade include mediastinal malignancy producing direct cardiac compression, such as lymphoma or small cell lung cancer.…”

Section: Specific Causes Of Pericardial Tamponade As Demonstrated At Ctmentioning

confidence: 99%

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Imaging Findings in Cardiac Tamponade with Emphasis on CT

Restrepo¹,

Lemos²,

Lemos³

et al. 2007

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Cardiac tamponade is a life-threatening condition that results from slow or rapid heart compression secondary to accumulation of fluid, pus, blood, gas, or tissue within the pericardial cavity. This condition can be associated with multiple causes including trauma, inflammation, scarring, or neoplastic involvement of the pericardial space among others. The main pathophysiologic event leading to tamponade is an increase in intrapericardial pressure sufficient to compress the heart with resultant hemodynamic impairment, which leads to limited cardiac inflow, decreased stroke volume, and reduced blood pressure. These events result in diminished cardiac output, which manifests clinically as a distinctive form of cardiogenic shock. Although cardiac tamponade is a clinical diagnosis, imaging studies play an important role in assessment and possible therapeutic intervention. Computed tomographic (CT) findings associated with cardiac tamponade include pericardial effusion, usually large, with distention of the superior and inferior venae cavae; reflux of contrast material into the azygos vein and inferior vena cava; deformity and compression of the cardiac chambers and other intrapericardial structures; and angulation or bowing of the interventricular septum. Familiarity with the clinical and pathophysiologic features of cardiac tamponade and correlation with the associated CT findings are essential for early and accurate diagnosis.

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Section: Page 1598mentioning

confidence: 98%

Section: Computed Tomographymentioning

confidence: 99%

Section: Specific Causes Of Pericardial Tamponade As Demonstrated At Ctmentioning

confidence: 99%

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Imaging Findings in Cardiac Tamponade with Emphasis on CT

Restrepo¹,

Lemos²,

Lemos³

et al. 2007

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169

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“…All image data sets were interpreted using a Sectra Workstation IDS7 (version 14.3.5.136, Sectra, Linkoping, Sweden), to describe the PMCT appearance of the HP, with particular attention being paid to hyperdense armoured heart (HAH), the PMCT sign described by Shiotani et al [20], and to annotate indirect CT signs of an increased intrapericardial pressure, as they are reported in the clinical literature [5][6][7][8][9][10][11][12][13][14][15]. In particular, the presence of the following CT findings was assessed: FHS, distension of hepatic and/or renal veins, compression of the coronary sinus and/or of the pulmonary trunk, periportal oedema.…”

Section: Methodsmentioning

confidence: 99%

“…The clinical literature reports some in vivo CT findings in cases of imminent PT [5][6][7][8][9][10][11][12][13][14][15]. They include pericardial effusion, flattened heart sign (FHS), bowing of the interventricular septum, compression of the coronary sinus and of the pulmonary trunk, dilatation of the superior vena cava (SVC) (with a diameter similar to or greater than that of the adjacent thoracic aorta) and of the inferior vena cava (IVC) (with a diameter greater than twice that of the adjacent abdominal aorta), distension of the hepatic and renal veins, periportal oedema and reflux of contrast into the azygos vein and IVC.…”

Section: Introductionmentioning

confidence: 99%

Role of post-mortem computed tomography (PMCT) in the assessment of the challenging diagnosis of pericardial tamponade as cause of death in cases with hemopericardium

et al. 2015

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Clinical implications of immediate or later periportal edema in MS-CT trauma scans: surrogate parameter of intravenous fluid status and venous congestion

Kleber

Buschmann

2012

Emerg Radiol

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Periportal edema (PPE) of the liver in multislice computed tomography (MS-CT) scans that develops immediately (primary PPE [pPPE]) or later (secondary PPE [sPPE]) is not uncommon in severe trauma patients. Although PPE may serve as a marker for blunt abdominal trauma (22-31 % of cases), distinct causes and clinical implications of PPE are unclear. We analyzed the incidence of pPPE and sPPE in 68 MS-CT scans in severe trauma patients (2007-2009). Exclusion criteria were severely burned patients and patients with preexistent liver diseases predisposing to PPE. We divided PPE+ patients into two subpopulations-either initial/primary PPE (pPPE+) or later/secondary PPE (sPPE+). Further patient data were collected and statistically analyzed. PPE+ was found in 27.9 % (n = 19). Females predominated (p = 0.01), and PPE+ patients presented with a significantly better pH at admission (p = 0.008). The total amount of volume resuscitation (1,983 ± 1,155 ml; p = 0.02) and crystalloids (1,117 ± 796 ml; p = 0.006) administered before MS-CT scans was significantly higher in PPE+, whereas the amount of administered colloids (797 ± 640 ml) showed no significant difference in both groups. PPE+ was not associated with further patient data, i.e., trauma mechanism, injury severity, prognosis-relevant factors, adverse clinical events, or mortality. pPPE+ in MS-CT may serve as a surrogate parameter for intravenous volume load and/or venous congestion, and sPPE+ may also indicate venous congestion and right heart failure after severe trauma. In severe trauma patients with pPPE+/sPPE+ in MS-CT scans, causes of PPE relating to intravenous fluid overload and/or venous congestion should be excluded or treated.

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Periportal lymphatic distension resulting from cardiac tamponade: CT findings and clinical-pathologic correlation

Cited by 11 publications

References 12 publications

Imaging Findings in Cardiac Tamponade with Emphasis on CT

Imaging Findings in Cardiac Tamponade with Emphasis on CT

Role of post-mortem computed tomography (PMCT) in the assessment of the challenging diagnosis of pericardial tamponade as cause of death in cases with hemopericardium

Clinical implications of immediate or later periportal edema in MS-CT trauma scans: surrogate parameter of intravenous fluid status and venous congestion

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