Splenic vein stenosis and thrombosis causes a localized form of portal hypertension known as left-sided hypertension and as a consequence, splenic vein stenosis and thrombosis may be complicated by the formation of varices, with the potential of massive upper . Abdom Imaging Find similar topics on :: Scholar:: Radiology search engine 5. London We offer you Autonomy, Flexibility . Splenic . Splenic varices usually traverse the splenocolic ligament and are seen as dilated veins in the anteroinferior aspect of the spleen [ 20 ]. Variant anatomy Anomalies of hepatic artery origin and number are common 10,20-23 ( Table 12-2 ). Specialty: Radiology Cross Sectional Grade: Consultant Location: London Job Description Are you an experienced Radiology Cross Sectional Consultant looking for an exciting new 11 days ago more. What is splenic artery aneurysm? It is therefore essential for preoperative evaluation of the anatomical details of the spleno-portal venous axis to be made by imaging. The superior mesenteric vein (SMV) belongs to portal venous system, presents with a diameter of up to 1.2 cm and it is defined as aneurysmatic when it exceeds 1.4 cm in diameter together with loss of wall parallelism [1]. Its tributaries include the short gastric, left gastroepiploic, pancreatic, and inferior mesenteric veins (see Fig. Hepatic artery provides the remaining hepatic blood flow. The splenic vein drains the blood from the spleen in 2-6 branches at the hilus and forms, together with the superior mesenteric vein, the portal vein at the splenoportal confluence. There is a need to consider several factors in choosing whether to anticoagulate the patient. The branches of the splenic vein, which converge at the splenic hilus, are more readily identified. The distribution of venous collateral vessels and the frequency of their occurrence in these patients were then compared with CT findings in 17 patients with proved portal hypertension and normal CT findings in 20 patients. Find similar topics on :: Scholar:: Radiology search engine 6. Splenic vein (vena splenica) The splenic vein is a large vessel located retroperitoneally in the upper part of the abdominal cavity. Case Type. In addition to the spleen, it drains parts of the stomach, pancreas and the hindgut. In paediatric patients, 4mm is upper limit. Splenic lesions are commonly discovered incidentally at imaging, without clinical signs or symptoms that may aid in diagnosis. To the best of our knowledge, this represents the second reported case of an anteriorly placed splenic vein. Figure 3. (b) Distal splenorenal shunt: SV is detached from the portal vein (PV) and reattached to the LRV. The mechanism of splenic rupture in infectious mononucleosis is not completely understood. Results Liver injury can also be associated with bile duct, duodenal, pancreatic, bowel, and splenic injury. It can detect not only infringed lymph nodes but also pathological changes outside the junction. RSNA, 2005 Article History Published in print: July 2005 Edema, increase in cell size and lifting of the splenic capsule would suggest that stretching of the capsule may result in spontaneous hemorrhage. In patients without cirrhosis, the contrast medium rarely refluxes caudad in the portal vein but progresses cephalad through the liver. Once completed, the imaging referral form should be faxed to: 020 3594 3199. Discussion When wandering spleen is suspected, radiologic imaging should locate the ectopic spleen and evaluate the anatomy and patency of the splenic vessels. 96-7 ). Bastarrika G, Bilbao JI, Martnez-Cuesta A, Elorz M, Vivas I . The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. The maximal diameter of all aneurysms ranged between 19 and 50 mm (meanSD, 28.49 . A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. Electronic address: urossi76@hotmail.com. Normal diameter < 7 mm. View chapter Purchase book Splenic vein thrombosis is uncommon and is usually described in relation to abdominal disease such as pancreatitis or trauma. From 1944 to 1955, at the Ohio State University Hospital, 1 example was found among 358 splenectomies done for hematologic disorders. Configurations of the portal venous system aneurysms were fusiform in 37 patients and saccular in one. It runs in the splenorenal ligament in close association with the splenic artery . Sinistral Portal Hypertension; imaging findings and endovascular therapy. It should be noted that the tortuous splenic veins frequently seen at the hilum of the enlarged spleen should not be called perisplenic varices. Splenic artery aneurysm is defined as a condition where there is a focal dilation in the diameter of the splenic artery that is 50% greater than the normal vessel diameter. Much has been written about the myriad pathologic conditions that can occur in the spleen; however, there is little guidance on the approach to an incidental . Overview. Due to inaccessible splenic vein (one patient with history of splenectomy and 3 patients with unavailable splenic vein during the procedure), noninvasive direct puncture of superior ( n = 3) and inferior ( n = 1) mesenteric vein was conducted under ultrasound guidance to obtain access for PVR-TIPS. The portal vein (PV) is the main vessel of the PVS, resulting from the confluence of the splenic and superior mesenteric veins, and drains directly into the liver, contributing to approximately 75% of its blood flow . Splenic vein thrombosis is a blood clot that is obstructing the splenic vein, which is located on the surface of the spleen. The injection of a radiopaque substance, under pressure, through an umbilical vein catheter results in dispersion of the agent throughout the intrahepatic portal venous system. The splenic artery supplies blood not only to the spleen, but also to the esophagus, stomach, duodenum, liver, and pancreas. Figure 2. Portal imaging includes the main portal vein, the right and left intrahepatic portal vein branches, and the splenic vein. Normal diameter of the common hepatic duct is less than 5mm. Both penetrating and non-penetrating injury to the epigastric area result in injury to the left lobe of the liver. In mesenteric venous thrombosis, studies have shown that a CT scan of the abdomen has 90 percent accuracy. Relations While the literature on this topic is scarce, it seems that the consensus is that if splenic vein thrombosis is associated with portal hypertension, gastric or esophageal varices than splenectomy should be . Clinical Cases Authors. Although risk factors like portal hypertension and liver cirrhosis have been highlighted, the etiology remains to be clarified. Allegheny Health Network, Pittsburgh, PA. American Journal of Gastroenterology: October 2018 - Volume 113 - Issue - p S1611-S1612. Affiliations 1 Departamento de Imagen Diagnstica, Unidad de Radiologa Interventiva, E.O. 12-6B). We report a case of SVT in a patient with a previous history of pancreatitis . As such, the differential diagnosis and subsequent management are based primarily on imaging characteristics. 2 Departamento de Imagen Diagnstica, Unidad de . Splenic Vein Aneurysm: A Rare and Incidental Finding 2926. Link 31 Jan 1 note Portal and Splenic Vein Thrombosis nickthejam liked this radiologyreview posted this The natural course of splenic vein aneurysms is uncertain and because of this condition, the timing and type of treatment remain controversial . Behind the neck of the pancreas, it confluences with the superior mesenteric vein to form the portal vein. Although the splenic vein usually marks the dorsal margin of the body and tail of the pancreas, the tip of the gland may rarely curve dorsal to the splenic vein to simulate adrenal abnormalities ( Fig. The increased pressure in the splenic vein causes the spleen to enlarge, and other veins to dilate and twist in the esophagus and stomach; internal bleeding may occur. The majority of primary splenic NHL originates from B cells, characterizing splenomegaly. To better assess the vessel, a MRI-MRA scan was performed: besides confirming the U/S findings, it revealed a dilatation of splenic and portal vein propably due to a shunt between splenic artery and splenic vein, and a splenic vein aneurysm (Figs 3, 4, 5). What causes splenic varices? Author Information . Most common sites are the main portal vein and confluence of splenic and superior mesenteric veins, forming extra-hepatic portal vein aneurysm (EPVA). An intense inflammatory reaction, vasculitis and . Short gastric and . Splenic vein thrombosis (SVT) is a well-recognized complication of acute and chronic pancreatitis. We report such a case of anteriorly placed splenic vein in a 40-year-old female prospective renal donor. Morphologically there are three types of venous aneurysms: fusiform, saccular and diverticular [2]. Deceleration injuries may result in lobe rupture, hepatic vein avulsion and inferior vena cava injuries. New magnetic resonance (MR) imaging techniques have increased the role of MR imaging in detection and characterization of splenic diseases. Epidemiology Doppler ultrasound is the best initial diagnostic test in cases with a suspicion of splenic vein thrombosis when considering all these facts. Spectral Doppler waveform ultrasound of the splenic vein at the hilum shows a typical band-like flow profile with minimal respiratory fluctuations; flow is directed away from the transducer (away from the spleen). After a median of 234 days, the portal vein and its left or right branch were patent in 39% of anticoagulated patients (versus 13% initially), the splenic vein in 80% (versus 57% initially), and . It is associated with complications of significant gastrointestinal bleeding and high morbidity if the thrombus propagates. Interventional radiology . The Doppler US findings seen in the complications described are often subtle and nonspecific and may evolve over time. Splenic vein thrombosis is rarely diagnosed with certainty prior to surgery or autopsy. The definitive therapy for a wandering spleen is surgery. Normal canine spleen - The typical homogenous smooth echotexture can be seen, with an anechoic area representing a branch of the splenic vein (arrow). Methods: A computer search of radiology reports for a 1-year period found 52 patients with SVO diagnosed by absence of visualization of the splenic vein accompanied by the formation of the expected perigastric collateral veins. If a conservative management approach is chosen it is important to maintain a close follow-up with magnetic resonance angiography, CT scan or ultrasonography (controlling changes in aneurismal size and/or in luminal flow) ( 4 , 6 ). Note the hyperechoic capsule on the far border of the spleen. Splenomegaly appears to be a common accompaniment of splenic rupture in this disorder as seen in our case. It also treats the painfully enlarged spleen/hypersplenism and is preferred in adult patients. The most frequent sites of the aneurysms were the main portal vein in 20 (53%) and the splenic vein in eight (21%) of the 38 portal venous system aneurysms. The diagnosis of LSPH caused by idiopathic splenic vein stenosis was made by transhepatic portal and splenic venography with pressure measurements, which revealed a focal stenosis of the splenic vein near the splenic hilum, with a post-stenotic dilatation and short gastric veins draining into the LGV through the gastric wall varices. Normal peak systolic velocity of the splenic vein is 9-18 cm/sec. In postcholecystectomy patients up to 10mm is normal. Additionally, splenic lesion biopsy confirmed a diagnosis of NHL. Am J Surg 2008;196, 149 -154. A normal splenic vein doppler will make the diagnosis of splenic vein thrombosis highly improbable. Once in the liver, PV ramifies and reaches the sinusoids, with downstream blood being directed to the central vein at . For patients for more than 60 years, add one mm for every 10 years. 12-3 ). The splenic vein is formed by splenic tributaries emerging at the splenic hilum in the splenorenal ligament at the tip of the tail of pancreas. The most common causes of splenic vein occlusion are pancreatic diseases, such as pancreatic cancer, pancreatitis, or a pseudocyst. This is the . Thus, the radiologist must . Mohy-ud-din, Nabeeha MD; Bedi, Gurneet MD; Garg, Mrinal MD; Dhawan, Manish MD. Free ; 2926_A Figure 1. MR imaging is an excellent tool for diagnosis and evaluation of focal lesions and pathologic conditions of the spleen. Evaluation of the viability of the splenic parenchyma, including any areas of infarction, is important as it guides therapy. Perisplenic collaterals can communicate with the gastric veins. Clinical data were reviewed for sequela of SVO and clinical impact of the diagnosis. Computed tomography scan demonstrating a 2.5 cm density in the pancreatic tail . The splenic vein lies behind the upper border of the pancreas below the splenic artery (see Fig. In 1956 . Hospital Galliera, Gnova, Italia; Unidad de Radiologa Interventiva, Departamento de Tecnologa Avanzada de Diagnstico y Terapia, ASST Santi Paolo y Carlo-Hospital San Carlo Borromeo, Miln, Italia. The computed tomographic (CT) findings in 18 patients with angiographically proved, isolated splenic vein occlusion (SVO) were retrospectively analyzed. Splenic vein thrombosis (plural: thromboses) is an uncommon condition in which the splenic vein becomes thrombosed, that most frequently occurs in the context of pancreatitis or pancreatic cancer. However, various other cancers, such as colon, gastric, or renal cancers, have also been known to cause splenic vein occlusion. View similar jobs: Consultant Radiology Jobs in London; Jobs in London; Consultant In Gynaecology Radiology - Central London Save. Compared with other imaging examinations, PET/CT has a high sensitivity for NHL lesions. (a) Proximal splenorenal shunt following splenectomy in which the proximal end of the cut splenic vein (SV) is anastomosed to the left renal vein (LRV). The intrahepatic IVC and the three main hepatic veins are also interrogated . The main function of this blood vessel is to drain the venous blood from the spleen. The inferior mesenteric vein is the biggest vein which drains into the splenic vein (variance of 30 % into the superior mesenteric vein). gamna-gandy bodies in spleen gamna-gandy bodies in spleen gamna-gandy bodies in spleen Once completed, the imaging referral form should be faxed to: 020 3594 3199. For imaging and Dexa scan referral forms please visit the dedicated referral section on our website. In the several large series of splenoportograms reported in the literature since 1952, only single instances of thrombosis of the splenic vein have been demonstrated. Intrahepatic bile ducts: <2mm is normal. National Locums. Agarwal A, Kumar R, Agarwal S, Sing S. Significane of Splenic Vein Thrombosis in Chroinc Pancreatitis. Whilst, for the most part asymptomatic, splenic vein thrombosis increases risk of gastric varices and associated upper GI hemorrhage. Splenic vein thrombosis may result in portal hypertension.
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