Ultrasound detection of unusual spontaneous portosystemic shunts associated with uncomplicated portal hypertension.

Abstract

Seven cases of unusual spontaneous portosystemic shunts observed by ultrasonography in the last 8 months are reported, including mses of coronary vein varicocele and patent umbilical vein; two cases of spleno-retroperitoneal anastomosis. ; omphalo-ilio-caval anastomosis; superior mesenteric vein-inferior vena cava anastomosis~ spleno-renal anastomosis; and spleno-portal anastomosis and anastomosis from the splenic vein to the abdominal wall. One of these collateral vessels was also analyzed by pulsed Doppler flowmetry. The patients were either cirrhotic or had pre-hepatic portal hypertension (resulting from chronic pancreatitis) and gave no history of gastrointestinal bleeding or ascites. Two of these patients had previously undergone surgery for problems associated with cholestasis. In both cases, presurgical sonogmphic studies were used to guide the surgical procedures in the hope of preserving the anomalous connections. Furthermore, ultrasound detection of spontaneous portosystemic shunts was an important factor in interpreting the clinical symptoms of these patients. (Key words: portal hypertension ; portosystemic shunts, spontaneous)Real-time ultrasonography allows visualization of splanchnic vessels in patients with portal hypertension even though they may be asymptomatic and, therefore. not candidates for more invasive techniques. Only 15 per cent of patients with cirrhosis and 18 per cent of those with esophageal varices present with a gastrointestinal hemorrhage that would justify the use of arteriography, splenoportography, and/or percutaneous transhepatic portography prior to establishing the surgical approach. 1Collateral circulation via the umbilical vein, 2 -5 dilatation of the portal vein and its tributaries, and the absence of respiratory caliber variation in the splenic and/or superior mesenteric vein, 6 ·i with or without dilatation, are signs of portal hypertension that are routinely detected by ultrasonography. Promising findings have also been obtained by the analysis of portal vein flow with the echo-Doppler method. 8 Many authors have also reported signs of altemtion of the portal trunk, such as aneurysm 9 and thrombosis 10 with cavernous transformation 11 and neoplastic invasion, t 2 • 13 that confirm the ability of ultrasonography to furnish a preliminary diagnosis of the location and cause of obstruction. Reports on spontaneous collateral venous circulation are less common. 1 " -18 The frequency of these anomalies is still uncertain and some doubts exist as to their efficiency in decreasing pressure within the portal venous system. In order to further clarify the ultrasound appearances of spontaneous portosystemic connections and to stress the importance of visualization of these vessels prior to abdominal surgery, we report seven cases of spontaneous portosystemic shunts presenting peculiar morphologic and/or clinical characteristics observed by ultrasonography in the last 8 months.

A varicocoele mimicking a hydrocoele in a man with portal hypertension: a case report

“…Unusual portal-systemic shunts in portal hypertension have been recorded including communication between a coronary vein varicocoele and patent umbilical vein, superior mesenteric vein and inferior vena cava, splenic vein and abdominal wall, spleno-retroperitoneal and omphalo-ilio-caval anastomosis [ 1 ]. Large scrotal varicocoeles secondary to portal hypertension have been described [ 2 , 3 ].…”

Sonographic Evaluation of Portal Hypertension in Children

“…Consequently, collateral channels develop to relieve this pressure. A variety of alternative pathways have been shown to shunt blood flow from the portal to the systemic circulations (10,11), but several major portosystemic anastomoses exist. Esophageal varices are communications between azygos vein tributaries and the left gastric vein.…”

A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

“…Percutaneous tosystemic shunts). Noninvasive, nonexpensive, harmless, and rapid techniques are ultrasonography [8,[44][45][46], real-transhepatic portography, improved by ultrasonically guided puncture, may be performed with little risk and time/pulsed Doppler ultrasonography (capable of determining the direction and rate of blood flow in large veins) is proved to be superior with regard to delineation of the portal venous system and esophageal varices [56,57]. In [17,47], color Doppler sonography, and duplex Doppler ultrasonography [21,[48][49][50].…”