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Thrombotic Venous Diseases of the Liver.

Sabol TP, Molina M, Wu GY - J Clin Transl Hepatol (2015)

Bottom Line: Thrombotic venous diseases of the liver do not occur frequently, but when they do, they can present as difficult diagnostic and therapeutic challenges.The aim of this article is to review the epidemiology, pathogenesis, diagnosis, and therapeutic options of these serious vascular problems.

View Article: PubMed Central - PubMed

Affiliation: Department of Graduate Medical Education, Eastern Connecticut Health Network, Manchester Memorial Hospital, Manchester, CT, USA.

ABSTRACT
Thrombotic venous diseases of the liver do not occur frequently, but when they do, they can present as difficult diagnostic and therapeutic challenges. The aim of this article is to review the epidemiology, pathogenesis, diagnosis, and therapeutic options of these serious vascular problems.

No MeSH data available.


Related in: MedlinePlus

Contrast-enhanced CT.A, Axial cut showing filling defects are present in the right, middle, and left hepatic veins (yellow arrows) and intrahepatic inferior vena cava (IVC) (blue arrow). Associated perfusional alterations of the liver are seen. Partially visualized is a hypodense mass in the anterior left hepatic lobe (white arrow); B, Coronal cut showing a hypodense thrombus involving the intrahepatic IVC extending into the right atrium (yellow arrow).
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f04: Contrast-enhanced CT.A, Axial cut showing filling defects are present in the right, middle, and left hepatic veins (yellow arrows) and intrahepatic inferior vena cava (IVC) (blue arrow). Associated perfusional alterations of the liver are seen. Partially visualized is a hypodense mass in the anterior left hepatic lobe (white arrow); B, Coronal cut showing a hypodense thrombus involving the intrahepatic IVC extending into the right atrium (yellow arrow).

Mentions: Doppler ultrasound, MRI, and CT angiography are the most frequently used imaging techniques to assist in the diagnosis of BCS.2 Ultrasound in the acute stage can demonstrate hepatic vein thrombus as intraluminal hyperechogenicity with lack of color and spectral doppler flow. Secondary, less specific findings on ultrasound include gallbladder edema, pleural effusion, and ascites. Chronic cases may show portosystemic collateral circulation and splenomegaly.39 Contrast enhanced CT (Fig. 4A and 4B) or MRI can demonstrate hypodense or hypointense filling defects in the hepatic veins, respectively. The use of CT and MRI may be a useful tool to distinguish BCS from liver cirrhosis through visualization of the caudate vein. Caudate vein dilatation and enhancement are due to intrahepatic collateral venous flow from other lobes. This was found by comparing MR images of BCS patients with control subjects. One study noted that 80% of patients with BCS had intrahepatic collateral veins.34 Furthermore, hypertrophy of the caudate lobe can compress the inferior vena cava (IVC). Typically, liver cirrhosis is associated with extrahepatic collateral venous circulation, whereas BCS may involve both extrahepatic and collateral intrahepatic circulations. The use of MRI may be a useful tool in distinguishing chronic BCS from liver cirrhosis by imaging the caudate vein.34


Thrombotic Venous Diseases of the Liver.

Sabol TP, Molina M, Wu GY - J Clin Transl Hepatol (2015)

Contrast-enhanced CT.A, Axial cut showing filling defects are present in the right, middle, and left hepatic veins (yellow arrows) and intrahepatic inferior vena cava (IVC) (blue arrow). Associated perfusional alterations of the liver are seen. Partially visualized is a hypodense mass in the anterior left hepatic lobe (white arrow); B, Coronal cut showing a hypodense thrombus involving the intrahepatic IVC extending into the right atrium (yellow arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663200&req=5

f04: Contrast-enhanced CT.A, Axial cut showing filling defects are present in the right, middle, and left hepatic veins (yellow arrows) and intrahepatic inferior vena cava (IVC) (blue arrow). Associated perfusional alterations of the liver are seen. Partially visualized is a hypodense mass in the anterior left hepatic lobe (white arrow); B, Coronal cut showing a hypodense thrombus involving the intrahepatic IVC extending into the right atrium (yellow arrow).
Mentions: Doppler ultrasound, MRI, and CT angiography are the most frequently used imaging techniques to assist in the diagnosis of BCS.2 Ultrasound in the acute stage can demonstrate hepatic vein thrombus as intraluminal hyperechogenicity with lack of color and spectral doppler flow. Secondary, less specific findings on ultrasound include gallbladder edema, pleural effusion, and ascites. Chronic cases may show portosystemic collateral circulation and splenomegaly.39 Contrast enhanced CT (Fig. 4A and 4B) or MRI can demonstrate hypodense or hypointense filling defects in the hepatic veins, respectively. The use of CT and MRI may be a useful tool to distinguish BCS from liver cirrhosis through visualization of the caudate vein. Caudate vein dilatation and enhancement are due to intrahepatic collateral venous flow from other lobes. This was found by comparing MR images of BCS patients with control subjects. One study noted that 80% of patients with BCS had intrahepatic collateral veins.34 Furthermore, hypertrophy of the caudate lobe can compress the inferior vena cava (IVC). Typically, liver cirrhosis is associated with extrahepatic collateral venous circulation, whereas BCS may involve both extrahepatic and collateral intrahepatic circulations. The use of MRI may be a useful tool in distinguishing chronic BCS from liver cirrhosis by imaging the caudate vein.34

Bottom Line: Thrombotic venous diseases of the liver do not occur frequently, but when they do, they can present as difficult diagnostic and therapeutic challenges.The aim of this article is to review the epidemiology, pathogenesis, diagnosis, and therapeutic options of these serious vascular problems.

View Article: PubMed Central - PubMed

Affiliation: Department of Graduate Medical Education, Eastern Connecticut Health Network, Manchester Memorial Hospital, Manchester, CT, USA.

ABSTRACT
Thrombotic venous diseases of the liver do not occur frequently, but when they do, they can present as difficult diagnostic and therapeutic challenges. The aim of this article is to review the epidemiology, pathogenesis, diagnosis, and therapeutic options of these serious vascular problems.

No MeSH data available.


Related in: MedlinePlus