Observation of portal circulation through superior mesenteric vein by enteric coated capsule of thallium-201

A new method of oral administration of an enteric coated capsule of ²⁰¹Tl (²⁰¹Tl-capsule) was developed to evaluate the portal circulation through the superior mesenteric vein (SMV). The ²⁰¹Tl-capsule was not collapsed in the artificial gastric juice, whereas it melted soon after soaking in the artificial intestinal juice. In a clinical trial of 42 cases, ²⁰¹Tl was satisfactory released in the duodenum in 36 cases where clear liver images were observed except in 1 patient. Heart to liver ratio (H/L) at 60 or 90 min after duodenal release of ²⁰¹Tl was 0.32±0.07 (mean±1 s.d.) in normal controls, 0.34±0.12 in chronic hepatitis, 0.31±0.12 in acute hepatitis, 0.45±0.13 in liver cirrhosis and 0.48±0.32 in cirrhosis with hepatocellular carcinoma. In 11 patients who had both oral and rectal studies with ²⁰¹Tl, 7 showed a high H/L ratio of more than 0.8 in the rectal study but only 1 showed a similarly high ratio of 1.07 in the oral study. In the group of varied liver disorders we have studied so far, it was found that most of the SMV blood flowed into the liver and the degree of portal systemic shunting (PSS) from the SMV was much smaller compared to that from the inferior mesenteric vein. The present study with oral administration of the ²⁰¹Tl-capsule was of value in understanding portal circulation through the SMV, however, this technique seemed of limited usefulness for evaluating overall pathologic PSS.     

Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt

Portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) is a valuable technique in the treatment cirrhosis and portal vein (PV) thrombosis. Only a few studies have reported cases of utilizing the transmesenteric approach in the procedure''s initial portal access. Here, we report the successful utilization of a CT-guided percutaneous puncture of the superior mesenteric vein (SMV) for PVR-TIPS in a patient with splenic vein thrombosis. A 54-year-old male with a history of morbid obesity (BMI: 44.67), hepatitis C, NASH cirrhosis, esophageal varices, and complete PV thrombosis presented for PVR-TIPS. An initial percutaneous transplenic approach was attempted, but was aborted due to the discovery of a splenic vein thrombosis. Subsequently, the patient was brought back into the hybrid-angio CT suite, and the SMV was accessed percutaneously with a 21-gauge needle under 4D CT-guidance. A 5-Fr micropuncture sheath was then placed. Additional portal venogram confirmed PV thrombosis. Right internal jugular vein (IJV) access was then obtained, and the right hepatic vein was catheterized. A loop snare was advanced from the SMV access into the right PV. A Colapinto needle was later positioned in the right hepatic vein, and the right PV was accessed using the loop snare as a target. A wire was then advanced and captured by the snare, and brought down through the PV. The tract was dilated with a 10 mm balloon, and a Viatorr stent was deployed. Balloon embolectomy of the SMV, splenomesenteric vein, and TIPS were then performed with a CODA balloon with improvement in flow through the TIPS on final portal venogram. Portosystemic gradient was 11 mmHg initially and 10 mmHg post-TIPS. Follow-up TIPS venogram in 3 weeks showed a widely patent TIPS. CT-guided percutaneous SMV access may serve as valuable technique in PVR-TIPS when traditional modes of initial portal access for recanalization are unobtainable.     

门静脉和肠系膜上静脉血栓形成的MRI诊断

目的 分析门静脉（PV）和肠系膜上静脉（SMV）血栓形成的MRI特征及其诊断价值。方法 搜集经手术与病理证实的PV和SMV血栓形成患者12例，全部行MR T1WI、T2WI、抑脂T2、血管成像及钆喷替酸葡甲胺（Gd-DTPA）3期动态增强扫描。结果 直接征象为血管内血栓信号（12例），表现为T1WI和T2WI显示PV和SMV流空信号消失。3例急性期血栓T。WI为低或等信号，T2WI为高信号；8例亚急性期血栓T1WI及T2WI均为高信号；1例慢性期血栓T1WI为混杂信号，T2WI为低信号；增强扫描静脉期PV、SMV管腔内无对比剂充盈，PV周围呈轨道样增强，其内无强化的低信号血栓。间接征象包括肠腔扩张积液（10例）、肠管积血（6例）、肠壁增厚（12例）、肠黏膜水肿（11例）、薄纸样肠壁（1例）、缆绳征（11例）、肠系膜积液（2例）、肠壁积气（3例）、腹腔积液（12例）、PV海绵样变（3例）、肝脏异常灌注（6例）。结论 MRI是诊断PV和SMV血栓形成并肠道缺血敏感有效的方法，MR多序列、多轴面成像及增强扫描对病变的显示、定位、范围及血栓的分期等有重要作用。     

CT demonstration of portal and superior mesenteric vein thrombosis in hepatocellular carcinoma

Three cases of hepatocellular carcinoma in which computed tomography (CT) demonstrated thrombosis of the portal vein are reported. In one patient, extension of the thrombus into the superior mesenteric vein was identified as well. The outstanding CT features of portal vein thrombosis were: (a) enlargement of the vein, (b) intraluminal low density area, and (c) hyperdense peripheral ring due to the enhancement of the venous wall. These findings may be useful in differentiating hepatocellular carcinoma from hepatic metastases.     

Preoperative angiography of the superior mesenteric and portal vein with prostaglandin F2 alpha in portal hypertension

In a comparative study, we showed that a gain in diagnostic reliability justifies the routine use of PGF in indirect superior mesenteric venograms of patients with portal hypertension. Three radiologists without knowledge of patients' data and treatment analyzed 30 angiograms with and 30 examinations without PGF. Complicating factors, such as presence of varices and dose of contrast medium (CM), were taken into account by a Mantel and Haenszel procedure. When PGF was used, intrahepatic portal branches could be outlined beyond their second ramification more frequently. The superior mesenteric and portal veins, but not the confluence, were visualized significantly more often using this agent, so that patency, constriction, partial thrombosis or occlusion could be reliably diagnosed. Independent of the use of PGF, visualization of the confluence was improved by high CM doses in combination with high flow rates.     

Aneurysm of the superior mesenteric vein

A superior mesenteric vein aneurysm was diagnosed by ultrasound, computed tomography, and angiography in a 55-year-old woman. It was successfully treated by partial resection and reconstruction of the confluent veins.     

Aneurysm of the superior mesenteric vein]

Aneurysms originating in the superior mesenteric vein are extremely rare: 4 cases have been reported in the international literature. The authors describe a case of a female patient admitted to hospital for vague abdominal pain. The CT findings revealed a cyst-like neoformation. By means of angiography it was then identified as a dilatation of the superior mesenteric vein. The causes of such dilatations are not altogether clear. Current interpretations refer to possible congenital and acquired factors, as well as trauma. The accompanying symptoms are abdominal pain, icterus, gastrointestinal haemorrhage or portal hypertension, but occasionally patients may present no symptoms whatsoever.     

Aneurysm of the extrahepatic portal vein associated with segmental portal hypertension and spontaneous porto-caval shunting through the inferior mesenteric vein.

A case of a congenital aneurysm of the extrahepatic portal vein is reported. It was complicated by segmental portal hypertension of the territory of the inferior mesenteric vein, which was a pathway for spontaneous porto-caval shunting.     

Simultaneous thrombosis of superior mesenteric artery and superior mesenteric vein following chemotherapy: MDCT findings

A case of acute mesenteric ischemia due to thrombosis of superior mesenteric artery and vein in a 44-year-old woman following chemotherapy for invasive laryngeal carcinoma was diagnosed on a multi-detector CT scan. Although the link between malignancy and thromboembolism is widely recognized in patients with cancer, chemotherapy further elevates the risk of thrombosis. Acute mesenteric ischemia associated or not associated with chemotherapy rarely occurs in patients with cancer. Moreover, co-occurrence of superior mesenteric artery and superior mesenteric vein thrombosis is reported for the first time.     

Aneurysms of the spleno-portal axis and the superior mesenteric vein. Observation of 4 cases

Four asymptomatic cases are reported of aneurysms of the spleno-portal and mesenteric veins. These ectasias, whose etiology is most probably congenital, are very rare (about 20 cases in world literature), especially if compared with aneurysms of the splenic arteries, and they are mainly occasional findings. Complications may occur in the biliary tract and duodenal loop, often associated with portal hypertension. US and CT are sometimes very valuable in characterizing them, but an angiographic map is needed for the patients who will undergo surgery. Angiographic procedure is also mandatory for interventional approach in case of porto-caval fistulas. Doppler US scanning seems to be the best technique for the follow-up.     

Non-traumatic rupture of the superior mesenteric vein with hemoretroperitoneum

Summary A case of rupture of the superior mesenteric vein with hemoretroperitoneum is described. The autopsy revealed the presence of an acute pancreatitis and thrombosis of the superior mesenteric artery. From the histological findings it appeared that the acute pancreatitis had damaged the venous wall from the outside and that the portal system overload, caused by the superior mesenteric artery thrombosis and the anomalous termination of the inferior mesenteric vein, acted from the inside of the vein causing its rupture. To our knowledge this is the first report of a rupture of the superior mesenteric vein caused by acute pancreatitis and resulting in hemoretroperitoneum.     

Aneurysm of the superior mesenteric vein: imaging findings

The authors report two uncommon cases of incidental superior mesenteric vein aneurysm in two asymptomatic women. Patients underwent ultrasonography, CT and MR angiography. The etiology, clinical features and treatment are discussed along with a review of to the literature.     

急性肠系膜上静脉血栓形成26例围手术期护理

急性肠系膜上静脉血栓形成约占肠缺血疾病的15%~20%[1],因其临床症状及体征无特异性,误诊率高达90%~95%[2],病死率高达30%~60%[1]。因此,近早确诊挽救患者的同时,实施积极有效的护理尤为重要。现将我院收治的急性肠系膜血栓形成26例手术患者护理体会报告如下。1临床资料1.1一般     

CT findings in acute thrombosis of superior mesenteric vein aneurysm

The CT findings in a case of surgically proven thrombosed aneurysm of the superior mesenteric vein are described. The location of the aneurysm and recognition of the CT features of venous thrombosis may allow preoperative diagnosis.     

肠系膜静脉结扎致急性肠缺血的多层螺旋CT研究

目的 探讨MSCT显示肠系膜静脉结扎致急性肠缺血的早期征象及其动态演化规律.方法 12只巴马猪,采用数字表法随机分成3个实验组(术后6、12、18 h组)和1个对照组,每组3只.实验组9只猪剖腹结扎肠系膜上静脉(SMV)主干远端空肠、回肠和回结肠支,分别于术前及术后6、12和18 h采用MSCT行平扫和增强后动脉、静脉和延迟期扫描.对照组3只猪仅剖腹分离暴露SMV,并于上述时间点进行扫描,比较手术前后肠系膜血管、肠道、腹腔形态的动态变化,结果与病理对照.结果 9只实验组猪均显示急性肠缺血病理改变,随时间延长,缺血进行性加重.CTA可准确显示SMV主干、大属支及其远端小分支直至肠壁边缘的直小静脉,显示SMV分支各结扎点.静脉堵塞性肠缺血的早期CTA改变为肠系膜上动脉痉挛、充盈欠佳、显影延迟和延长;SMV显影淡、延迟;肠壁增厚,系膜水肿,腹水,肠壁强化高于正常;随时间推移,出现肠壁变薄,肠腔扩张、积液,系膜水肿,腹水加重,肠壁强化减弱.结论 CTA能清晰显示肠系膜血管解剖、堵塞的静脉、早期肠缺血改变及其动态演化规律,于病变早期可靠地诊断静脉堵塞性肠缺血.