Superior vena caval syndrome: color flow Doppler detection of collateral venous channels.

Thrombosis of the superior vena cava (SVC) is an important clinical problem that requires prompt diagnosis. Confirmation of suspected SVC syndrome requires the use of an imaging study to document the obstruction and presence of collateral venous channels. Echocardiography is often used to evaluate suspected SVC obstruction; however, previous methods have allowed only indirect detection of collateral flow. We describe 3 patients with SVC obstruction in whom color flow Doppler allowed direct demonstration of collateral venous channels.     

Altered flow dynamics of intravascular contrast material to the liver in superior vena cava syndrome: CT findings

Background: To evaluate the findings of altered flow dynamics in the livers of patients with obstruction of superior vena cava (SVC) on helical computed tomography (CT). Methods: In six patients (age range = 28–80 years) with SVC obstruction, CT findings were retrospectively reviewed to identify the abnormal enhancement patterns of the liver and the relation with the extrahepatic collateral vessels and hepatic vessels. Results: Abnormal hepatic enhancement was observed in the following four (A–D) portions: (A) anterior portion of segment IV (n = 5), (B) subdiaphragmatic portion of the liver (n = 4), (C) posterior portion of the right lobe (bare area; n = 1), and (D) lateral segment of the left lobe (n = 2). Two major collateral pathways to the liver were demonstrated as follows: A and D → from the umbilical vein to the left portal vein, and B and C → from the subcapsular vein to the bare area of the liver or to the hepatic veins. On helical CT, these collateral pathways were also clearly visualized. Conclusion: When these abnormal enhancements of the liver on CT are recognized within the liver, these findings indicate diversion of contrast material into collateral pathways to the liver with SVC obstruction. Received: 31 March 1999/Revision accepted: 25 June 1999     

Shock due to superior vena cava obstruction detected with point of care ultrasound

Superior Vena Cava (SVC) syndrome is caused by SVC obstruction by external compression or intraluminal thrombus. Patients with the condition can present with upper body swelling, shortness of breath and shock. This case report highlights the use of point-of-care ultrasound (POCUS) to evaluate a patient with SVC syndrome in the emergency department. The test offers many advantages over computed tomography (CT), venography, and magnetic resonance imaging which are limited in hemodynamically unstable patients. A 60-year-old male presented with acute respiratory distress and shock. The POCUS showed the presence of a right lung consolidation and SVC thrombus. CT revealed the presence of a large mediastinal mass causing compression of the SVC with clot seen inside the vessel. The patient was thrombolysed with intravenous streptokinase and his hemodynamics improved. Further investigation confirmed the diagnosis of lymphoma. The SVC can be visualized with transthoracic echocardiography using either the suprasternal, right supraclavicular or right parasternal approach. In this case, the presence of consolidation of the right lung mass provided an acoustic window for the visualization of the SVC using the right parasternal view, thereby allowing for more rapid diagnosis and management.     

Pacemaker-induced superior vena cava syndrome: clinical evaluation of long-term follow-up

BACKGROUND: Pacemaker-induced superior vena cava (SVC) syndrome is a rare but serious complication of permanent pacemaker implantation. Because of its rarity, little is known about the long-term prognoses of such patients. METHODS: Five patients, mean age 62 +/- 11.4 years, with pacemaker-induced SVC syndrome for more than 10 years were investigated. The clinical evaluation included: exercise testing, thrombophilia lab tests, and a chest CT. RESULTS: Two of the patients manifested complications of SVC syndrome which included thoracoabdominal subcutaneous collaterals. One of these patients simultaneously developed an increase in the pacing threshold which required the implantation of epicardial leads. Three of the five patients had normal age-adjusted VO(2) AT und VO(2) max. Four of the patients were both heterozygous for a polymorphism of PAI-1 and were homozygous for a polymorphism of t-PA. One of these patients also was heterozygous for a polymorphism of factor V and glycoprotein IIb/IIIa. The chest CTs revealed extensive and varying collateral circulation patterns in all of the patients. CONCLUSIONS: The development of pacemaker-induced SVC syndrome is the result of various predisposing factors including thrombophilia. Many patients retain normal age-adjusted cardiopulmonary capacity and demonstrate stable clinical findings on the long-term as the result of the development of extensive collateral vessel systems. The most serious complication was the combination of SVC syndrome and the simultaneous malfunctioning of one of the leads requiring implantation of a new lead.     

Endoscopic ultrasonographic study of the azygos vein before and after endoscopic obliteration of esophagogastric varices by injection sclerotherapy

BACKGROUND AND STUDY AIMS: The azygos vein plays an important role as a drainage system for the superior portosystemic collateral circulation in portal hypertensive patients. Endoscopic ultrasonography (EUS) and Doppler EUS allow the performance of hemodynamic studies of the azygos vein. In this study, we observed the changes in the azygos vein which occur with variceal obliteration by endoscopic injection sclerotherapy (EIS). PATIENTS AND METHODS: We recruited patients with portal hypertension and bleeding varices who were not on portal pressure-lowering agents and who were scheduled for the EIS program. EUS was performed in these patients to study the azygos vein at the start of EIS. The azygos vein diameter, maximal velocity (Vmax), and blood flow volume index (BFVI) were measured. After variceal obliteration and within 1 week, another EUS study of the azygos vein was carried out. RESULTS: Out of 40 patients recruited into the study variceal obliteration and EUS assessment of the azygos vein, within 1 week of obliteration, was achieved in 33. We noticed a significant increase in azygos vein diameter (P<0.001) and BFVI (P=0.001) following variceal obliteration. No significant change was observed in Vmax (P>0.05). In one patient, marked caliber irregularities were observed in the azygos vein after variceal obliteration. CONCLUSIONS: Using EUS and Doppler EUS, hemodynamic studies of the azygos vein blood flow can be performed, allowing the monitoring of the effects of EIS and variceal obliteration on the superior portosystemic collateral circulation. The clinical significance of the observed changes in azygos blood flow that occur with variceal obliteration should be investigated in further studies and correlated with short-term and long-term outcome.     

电子束CT增强双期扫描和血管重建对Budd-Chiari综合征的评价

目的 分析Budd-Chiari综合征的CT增强双期扫描影像学征象，评价血管三维重建的临床意义。方法 32名患者CT扫描增强动脉期延迟时间为30s，门脉期延迟时间为70s。血管三维重建方式为表面阴影遮盖法(SSD)和多平面重建法(MPR)。所有患者均进行了下腔静脉数字减影血管造影。结果 下腔静脉梗阻：隔膜性5例，闭塞性15例，狭窄性12例。肝静脉完全梗阻10例，不完全梗阻14例。可发现有两种肝外侧支循环形成，其中10例有肝内侧支循环形成。SSD法血管重建可显示血管和侧支循环总体情况，而MPR法可多角度直接显示血管。结论 电子束CT增强双期扫描和血管三维重建可全面评价Budd—Chiari综合征的血管和器官病变状况。     

布加综合征的螺旋CT诊断(附6例分析)

目的:通过总结,加深认识布加综合征的CT表现及临床特点,提高本病的影像诊断率,减少临床漏诊及误诊;材料与方法:回顾2000年——2010年收集的6例布加综合征,经DSA诊疗证实,行腹部CT平扫加增强,分析其各种临床症状及CT征象;结果:CT表现肝硬化4例,脾大4例,腹水2例,肝段下腔静脉充盈缺损5例,胸腹部侧枝静脉形成或静脉曲张5例。结论:加强对布加综合征的认识,认真分析病史及临床症状,仔细阅读CT影像,应该能对布加综合征做出准确的影像学诊断。     

Recurrent acute Budd–Chiari syndrome after right hepatectomy: US color-Doppler vascular pattern and left hepatic vein stenting for treatment

After extended right hepatectomy remnant liver can be affected by outflow obstruction due to torsion of the inferior vena cava or kinking of the left hepatic vein. Remnant liver fixation is therefore suggested to avoid postoperative acute Budd–Chiari syndrome. Despite remnant liver reposition during surgery, a 76-years-old woman developed complete outflow obstruction. This clinical situation, due to left hepatic vein kinking, was suspected by US examination and confirmed by CT scan that showed a pathological intrahepatic vascular pattern. Patient required urgent relaparotomy and the liver was replaced in normal position. However, recurrence of outflow obstruction occurred and it was ultimately treated by inferior vena cava angiogram with left hepatic vein stenting.     

肺癌合并上腔静脉综合征的CT诊断

目的 探讨肺癌合并上腔静脉综合征(SVCS)的CT表现为早期诊断、紧急处理提供依据.方法 收集天津肿瘤医院自2001年7月至2010年3月病理确诊肺癌合并上腔静脉综合征50例,回顾性分析肺癌解剖部位、大体类型与其导致SVCS方式的CT表现之间的关系;回顾性分析上腔静脉梗阻程度与侧枝循环的建立与开放、胸壁水肿之间的关系,并分别做四格表或R×C表x2检验.结果 肺癌引起SVCS的方式包括直接侵犯7例,淋巴结转移16例,两者并存27例.不同部位不同大体类型肺癌引起SVCS的方式差异具有统计学意义(x2=30.012,P＜0.05).肺癌引起SVCS后的继发改变包括侧枝循环建立开放14例,胸壁水肿12例,两者均有15例,两者均无9例.肺癌引起SVCS时上腔静脉梗阻程度不同,胸部侧枝循环和胸壁水肿CT显示率不同(x2=12.881,P＜0.05).结论 CT增强检查可以全面诊断肺癌合并SVCS,能为该病的急诊处理提供依据.     

Budd-Chiari综合征64层CT动态增强扫描强化特征及CT血管成像分析

目的：探讨布-加综合征（Budd-Chiari syndrome,BCS）肝脏64层CT动态强化规律及成像基础,分析CT血管成像技术（CTA）在Budd-Chiari综合征中的应用价值.材料与方法：对1 1例Budd-Chiari综合征病人进行三期增强检查,并对相关血管分别行最大密度投影（MIP）、容积成像（VR）和多平面重建（MPR）,分析Budd-Chiari综合征患者肝脏64层CT动态强化的规律,并观察肝静脉、下腔静脉病变类型及肝内外侧枝循环情况.结果：11例螺旋CT动态增强的BCS患者3例为急性期,8例为慢性期.7例为肝静脉梗阻,4例为下腔静脉梗阻.门脉期肝脏周边强化型4例,中心强化型2例,斑片强化型1例,均匀强化4例.肝内侧支静脉开放6例,其它征象如肝肿大、肝脏尾叶增大、脾大、腹水、肝内外侧枝血管形成等表现也可见到.结论：64层螺旋CT动态增强扫描可无创性显示肝脏血流动力学变化,结合CTA技术,能直观、准确地显示血管梗阻平面及肝内、外侧支循环情况.     

Absence of the Superior Vena Cava: Difficulties for Pacemaker Implantation

Endocardial pacemaker electrode implantation can be difficult in patients with anomalous superior vena cava (SVC). Venography and CAT scan showed that the patient lacked SVC venous drainage and that systemic veins drained into the inferior vena cava through the azygos vein. A temporary stimulation electrode was placed by puncture of the femoral vein, permanent stimulation by venotomy of the epigastric vein, with the electrode inserted through the external iliac vein.     

Comprehensive evaluation of patients suspected with deep vein thrombosis using indirect CT venography with multi-detector row technology: from protocol to interpretation

With the increased availability of multi-detector row CT, indirect CT venography has become an important non-invasive image modality for patients with suspected deep vein thrombosis. Use of indirect CT venography can not only diagnose/exclude deep vein thrombosis, but can also determine if there are other anomalies or diseases which might contribute to the patient’s symptoms. In this pictorial essay, we introduce the scanning protocol, post-processing techniques, and interpretation algorithm used in widely available 64 multi-detector row technology. We discuss several cases, including deep vein thrombosis in acute and chronic stages, anatomic variation, vena cava filter, and collateral veins. Lastly, we consider alternative diagnoses including varicose veins, infection, prosthesis failure of arthroplasty, traumatic vessel injury, and other musculoskeletal conditions. Radiologists should be familiar with the comprehensive interpretation of indirect CT venography to facilitate differential diagnosis and further treatment decision.     

Takayasu's arteritis. Carotid duplex sonographic appearance, including color Doppler imaging

Takayasu's arteritis (also known as pulseless disease, aortoarteritis, and aortic arch syndrome) is a chronic inflammatory arteriopathy that affects the aorta and its main branches as well as the pulmonary arteries. We report the carotid duplex sonographic findings of Takayasu's arteritis in three patients. Takayasu's arteritis can be suspected by noting a long segment of diffuse, homogeneous, circumferential vessel wall thickening in the proximal common carotid artery, resulting in narrowing of the lumen. The internal and external carotid arteries are normal.     

Review of Budd-Chiari Syndrome

This study aims to report the Budd-Chiari syndrome clinical research status and progress that has occurred in over nearly 30 years in China, and emphasize the value of imaging in facilitating the diagnosis of Budd-Chiari syndrome based on more than 2500 cases. Findings on ultrasonography, computed tomography, magnetic resonance imaging, and digital subtraction angiography images are used to propose new Budd-Chiari syndrome types and subtypes. The new subtype classification presented here has important value for guiding interventional treatment. This study also proposes a new concept of anatomical and functional obstruction of hepatic vein that stresses the compensatory value of accessory hepatic vein and azygos vein and describes the risk of manipulation of the communication branch of inferior vena cava obstruction in interventional therapy.     

Asymptomatic Superior Vena Caval Occlusion: A Complication of Nonthoracotomy Implantation of Cardioverter Defibrillator

A patient with ischemic dilated cardiomyopathy and history of ventricular fibrillation received an implantable Cardioverter defibrillator by the nonthoracotomy approach. Four years later, during elective replacement of an exhausted pulse generator, a superior vena caval thrombotic occlusion with collateral circulation through the azygos and emiazygos vein systems was documented. This occlusion occurred despite an anticoagulant treatment in the standard therapeutic range. We speculate that thrombotic occlusion might be secondary to a mechanical vessel injury.     

彩色多普勒超声诊断下肢深静脉血栓形成后综合征

目的:评估彩色多普勒超声对下肢深静脉血栓形成后综合征的诊断价值。方法:采用高频彩色多普勒超声对134例下肢深静脉血栓形成后综合征进行治疗前后观察对比,观察下肢静脉的血管内径、内膜厚度、光滑度、血管压缩性、管腔内回声、静脉瓣功能、侧支循环、血流速度等指标。结果:134例中107例临床治愈,27例病情好转,超声检查显示管壁回缩正常,内膜光滑,血管压缩性恢复良好,侧支循环建立,静脉瓣功能不全有所改善。结论:高频彩色多普勒超声对下肢深静脉血栓形成后综合征的治疗诊断及评估有着重要临床价值。     

髂静脉受压综合征病因及影像学进展

髂静脉受压综合征是常见的临床综合征之一,诊断标准尚未统一。目前影像学检查在髂静脉综合征的诊断中具有重要价值,主要包括彩色多普勒超声、CT、MRI和血管造影等。本文针对髂静脉受压综合征的病因学及影像学研究进展进行综述。     

外伤后急性弥慢性脑肿胀的CT诊断与临床分析

目的：探讨外伤后急性弥漫性脑肿胀的CT征象及临床表现。材料与方法：回顾性分析52例外伤后弥漫性脑肿胀的CT征象及临床资料,其中46例患者进行了2—5次CT复查。结果：根据CT表现,将52例患者分为24例弥漫型和28例半球型。所有患者CT均表现为基底池（包括鞍上池、环池、四叠体池、大脑大静脉池）及第三脑室受压变窄或闭塞。其中基底池受压变形或部分变小12例,显著变窄25例,大部分或完全闭塞15例;第三脑室变小或显著变窄28例,闭塞15例,正常9例;第四脑室闭塞13例;双侧或单侧外侧裂池变窄或闭塞34例;脑挫裂伤23例,其中迟发性脑血肿6例,硬膜外或硬膜下血肿12例;中线结构移位39例;脑密度升高或减低44例。结论：基底池和第三脑室变小或闭塞可作为CT诊断外伤后弥漫性脑肿胀的可靠征象,基底池的闭塞可作为重型外伤后弥漫性脑肿胀的诊断依据。     

超声造影技术在评估髂股静脉血栓中的临床价值

目的 评价超声造影技术在评估髂-股静脉血栓中的临床应用价值。方法 应用超声造影技术评估经二维及彩色多普勒超声诊断髂-股静脉血栓患者43例,观察血栓头位置及形态,是否伴有侧枝血管形成。结果 超声造影检查可以清晰的显示二维及彩色多普勒已经诊断或疑似的髂-股静脉血栓病例43例,同时血栓头形态,轮廓及位置较二维及彩色多普勒显示清晰,部分患者存在侧枝血管。结论 超声造影可以更清晰显示血栓头位置,显示可能存在的侧枝血管,为临床提供更多信息。     

Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report

BACKGROUNDAzygos vein aneurysms are extremely rare, and their pathogenesis is not clear. The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination or by chance. There are few reports on the diagnosis of and treatment strategy for this disease. Moreover, the choice of therapeutic schedule and the treatment window are controversial.CASE SUMMARYWe report a case of azygos vein arch aneurysm in a 53-year-old woman. The patient had symptoms of back pain, chest tightness, and choking. Enhanced chest computed tomography showed a soft-tissue mass in the right posterior mediastinum, which was connected to the superior vena cava. The enhancement degree in the venous phase was the same as that of the superior vena cava. The patient received video-assisted thoracoscopic surgery. After the operation, her back pain disappeared, and her dysphagia and chest tightness were also significantly relieved. The postoperative pathology confirmed hemangioma. The patient was discharged on the seventh day after surgery without any comp-lications.CONCLUSIONSome patients with hemangioma of the azygos vein arch may experience dysphagia and chest tightness caused by the tumor compressing the esophagus and trachea. Enhanced computed tomography scanning is vital for the diagnosis of azygos vein aneurysms. In addition, despite the difficulty and risk of surgery, thoracoscopic surgery for azygos vein aneurysms is completely feasible.