肾静脉血栓形成的彩色多普勒超声征象及其诊断价值

目的 探讨肾静脉血栓形成（RVT）的彩色多普勒超声征象及其诊断价值。方法 回顾性分析9例RVT患者的彩色多普勒超声结果，观察肾结构、肾内血流信号的分布、肾静脉主干回声和血流充盈情况，测量段动脉或叶间动脉阻力指数。结果 肾静脉主干血栓形成9例（其中1例累及双侧），肾内小静脉血栓形成1例。肾静脉主干血栓形成表现为肾静脉主干充满实性回声或条索状回声，管腔内完全或部分血流充盈缺损，67％表现为肾内无或稀少静脉血流；肾内小静脉血栓形成表现为受累区肾结构模糊，无静脉血流信号。肾内动脉舒张期反向波预测RVT的敏感性为30％（3／10），余7侧RVT患者肾内动脉RI均升高（范围0．74～0．96，平均0．84）。结论 彩色多普勒超声可作为本病首选影像学检查方法，有助于临床迅速采取治疗措施和进行随访观察。     

肾静脉栓塞的彩色多普勒超声征象及其诊断价值

目的通过与增强CT对比分析,探讨彩色多普勒超声在肾静脉栓塞疾病中的诊断价值。 方法选取2014年1月至2017年9月在北京协和医院就诊的经手术病理或随访证实的40例45侧肾静脉栓塞患者,其中,15例20侧肾静脉血栓及25例25侧肾静脉癌栓,均行彩色多普勒超声及增强CT检查,总结肾静脉栓塞的超声表现,包括栓塞病灶的位置、受累静脉管腔及管壁特点、侧支形成情况及彩色多普勒表现。超声与增强CT诊断肾静脉血栓及癌栓的准确率比较采用χ²检验。 结果彩色多普勒超声对肾静脉血栓及癌栓的诊断准确性分别为85%、84%,CT增强扫描的诊断准确性依次分别为100%、96%,差异均无统计学意义（P均>0.05）。肾静脉栓塞的主要超声征象有：（1）肾静脉管腔扩张伴实性成分填充;（2）主干内血流中断或充盈缺损;（3）肾内无明显静脉血流信号或血流信号分布稀疏。 结论彩色多普勒超声与增强CT在诊断肾静脉栓塞上有较好的一致性,超声可作为评估肾静脉栓塞的重要影像学方式,结合病史能为肾静脉栓塞提供较为可靠的诊断依据。     

Aneurysms of the portal vein and superior mesenteric vein

Only scattered reports of portal vein and superior mesenteric vein aneurysms appear in the literature. Case reports of three patients with portal vein and superior mesenteric vein aneurysms diagnosed by computed tomography (CT) and gray-scale, color Doppler, and duplex Doppler sonography are presented. In one case, an isolated portal vein aneurysm was demonstrated. In the second case, an aneurysm of the portal vein and superior mesenteric vein resulting in biliary ductal dilatation was observed. In the third case, an isolated superior mesenteric vein aneurysm was found. None of the patients had a history or clinical evidence of underlying liver disease, pancreatitis, or other disease states that would predispose them to the development of aneurysms. The clinical presentations, possible etiologies, and imaging features of portal vein and superior mesenteric vein aneurysms are reviewed. The value of CT and sonography in the detection and characterization of these rare aneurysms is discussed. Received: 29 February 1996/Accepted: 10 April 1996     

Left adrenal vein localization by 3D real-time volume-rendering CTA before laparoscopic nephrectomy in living renal donors

Background: We investigated whether the left adrenal vein could be consistently localized on three-dimensional (3D) real-time volume-rendering computed tomographic angiographic (CTA) mapping in a group of living renal donors before laparoscopic nephrectomy. Methods: Sixty-six consecutive potential renal donors were referred for CTA vascular mapping before laparoscopic donor nephrectomy. Thirty-three patients were examined on a single-detector helical CT scanner and the other 33 were examined on a multidetector unit. In each patient, arterial phase and venous phase volumetric data sets were acquired after the intravenous injection of 150 cc of non-ionic contrast material. Three radiologists reviewed the data sets at a free-standing workstation after the application of 3D volume-rendering software and reached a concensus on whether the left adrenal vein was visualized and, when seen, its position relative to the abdominal aorta. Results: The left adrenal vein was found in 92.5% of the 66 donors (91% in the single-detector group and 94% in the multidetector group). The junction of the left adrenal vein and left renal vein averaged 5.2 mm (range = 0–13 mm) from the left lateral wall of the abdominal aorta. Conclusion: Three-dimensional real-time volume-rendering CTA with single-detector and multidetector scanners permits consistent localization of the left adrenal vein in more than 90 % of prospective living renal donors. Received: 7 September 2000/Accepted: 29 November 2000     

Intraoperative US diagnosis of pylephlebitis (portal vein thrombosis) as a complication of appendicitis: a case report

We report a case of infectious thrombosis of the superior mesenteric vein (pylephlebitis) that was suspected preoperatively with computed tomography and confirmed at intraoperative ultrasonography as confined to the extrahepatic portal vein and superior mesenteric vein. Intraoperative ultrasonography revealed intraluminal echogenic thrombus material in the dilated superior mesenteric and extrahepatic portal veins, slightly dilated open splenic vein, and numerous venous collaterals in the hepatoduodenal ligament. When preoperative imaging studies are inconclusive, intraoperative sonography can confirm the correct diagnosis of pylephlebitis and may give valuable information about the extent of the thrombosis. Received: 19 December 1995/Accepted: 31 January 1996     

Main renal vein invasion by a transitional cell carcinoma of the renal pelvis: Documentation with CT

Invasion of the main renal vein by transitional cell cancer of the renal pelvis is an infrequently reported event. No accurate clinical frequency of this phenomenon is available. Extensive invasion of the renal parenchyma by the tumor usually is present by the time it presents in the renal vein. This article represents but the second documenting main renal vein involvement depicted with computerized tomography in a patient with carcinoma of the renal pelvis.     

左肾静脉压迫综合征的二维超声和彩色多普勒超声表现

目的 探讨左肾静脉压迫综合征的声像学特征。方法 对22例左肾静脉压迫综合征患儿及15例正常儿童进行了二维超声及彩色多普勒超声检查。结果 病变组平卧位时左肾静脉在腹主动脉与肠系膜上动脉夹角处狭窄,左腹主动脉左侧扩张,扩张段血管内径是狭窄处的2倍以上,站立15分钟后扩张更明显,是狭窄处的3倍以上,左肾门肾静脉的血流速度较对侧明显减慢。结论 平卧位左肾静脉狭窄前扩张段内径与狭窄处内径比达2倍以上,站立15分钟后达3倍以上,平卧位时左肾门血流速度较对侧减慢是本病的重要超声表现和重要的诊断依据。     

Portal vein aneurysm: report of six cases and review of the literature

Portal vein aneurysm is very rare, and its relation to portal hypertension has been emphasized. We report six cases of portal vein aneurysm (five extrahepatic and one intrahepatic). All patients were asymptomatic and had no signs suggestive of portal hypertension; the lesion was incidentally detected by ultrasound. Color Doppler sonography showed a constant hepatopetal flow along the aneurysmal wall, which immediately led to the diagnosis. We stress the usefulness of color Doppler sonography for studying the hemodynamics of this vascular anomaly and briefly review the literature. Received: 29 December 1995/Accepted: 14 February 1996     

Liver transplant rejection: value of hepatic vein Doppler waveform analysis

Background: To determine whether abnormal hepatic vein Doppler tracings can be used to predict liver transplantation rejection. Methods: A total of 158 hepatic vein Doppler tracings were obtained on 93 postliver transplant patients (63 patients without rejection and 30 patients with biopsy-proven rejection). Hepatic vein Doppler tracings were scored according to an established grading system (0 = normal triphasic waveform, 1 = dampened waveform, with loss of flow reversal, 2 = completely flat waveform). The hepatic vein Doppler tracings were then correlated with biopsy findings. Results: In the group of 63 patients without rejection, 124 Doppler examinations were performed and graded as follows: 0 = 87 (70%), 1 = 31 (25%), and 2 = 6 (5%). In the group of 30 patients with biopsy-proven rejection, 34 Doppler examinations were performed and graded as follows: 0 = 16 (47%), 1 = 14 (41%), and 2 = 4 (12%). The sensitivity of abnormal hepatic vein Doppler tracings for detection of rejection was 53% and the specificity was 70%. The positive predictive value of an abnormal hepatic vein Doppler tracing was 33% and the negative predictive value of a normal Doppler tracing was 84%. Conclusions: Abnormal hepatic vein Doppler tracings are observed in patients with and without liver transplant rejection. Abnormal tracings cannot be used to predict liver transplant rejection. Received: 7 January 1997/Revision accepted: 17 April 1997     

Normal left renal vein mimicking left renal artery aneurysm

On transverse ultrasound scans a small number of patients with a paucity of retroperitoneal fat show an initial false impression of a left renal artery aneurysm due to the confluence of two normal findings. The left renal vein is unusually prominent from the hilum of the left kidney to the area between the superior mesenteric artery and the aorta; and part of the normal aortic wall, adjacent to the left renal vein, is incompletely imaged. Explanations for the prominence in the left renal vein and the partial visualization of the aortic wall are discussed, and various maneuvers that allow for accurate identification of both are described. The use of this analysis should prevent the incorrect diagnosis of a left renal artery aneurysm, which might lead to more invasive diagnostic procedures.     

多层螺旋CT对活体肾移植供体术前综合评价的初步研究

目的评价MSCT在活体肾供体术前综合评价中的价值。方法11例供体术前进行了MSCT三期增强扫描,均进行VR及MIP重组,观察肾实质、肾动脉、肾静脉以及集尿系统,并与9例手术结果进行对照分析。结果MSCTA显示23支肾动脉,包括左肾副动脉1例;23支肾静脉,包括1例左双肾静脉;23支肾盂输尿管,包括1例右侧双肾盂双输尿管。此外,还检出副肝静脉2例,脾动脉瘤1例。2例放弃手术,1例因肾血管原因,1例为乙肝病毒携带者;9例手术结果与MSCT所见完全吻合,准确率为100%。结论MSCT作为术前活体肾供体的一站式检查技术,有重要的临床应用价值。     

肾静脉血栓的彩色多普勒超声诊断

目的探讨彩色多普勒诊断肾静脉血栓的超声显像及诊断。方法回顾性分析6例肾静脉血栓患者肾脏大小结构,肾静脉主干回声和血流信号,肾内血流等彩色多普勒超声结果。结果肾静脉主干血栓5例,超声显示肾静脉主干充满实性条索状回声,管腔内完全或部分无血流信号显示;肾内小静脉血栓1例,局部区域肾结构模糊,无静脉血流信号。肾内动脉RI均升高(范围0.70～0.92,平均0.86),部分患者出现肾内动脉舒张期反向波。结论彩色多普勒超声诊断本病准确、实用、有助于指导临床治疗和随访观察。     

Acute hepatic vein occlusion: spiral CT findings in an experimental study

Background: We investigatedspiral computed tomographic (CT) findings and underlying hemodynamic alterations in acute hepatic vein occlusion. Methods: In nine dogs, immediately after balloon occlusion of the right (n = 4) or left (n = 5) hepatic vein through the transjugular or transfemoral route, we performed single-level dynamic CT with intravenous administration of contrast medium. We created time attenuation curves of individual hepatic segments showing attenuation differences. To investigate underlying hemodynamic alterations, hepatic arteriograms were obtained in two dogs. Results: In all cases, there were three compartments with different time attenuation curves: normal, occluded, and adjacent. The normal compartment, which comprised segments far from the occluded hepatic compartment, showed the normal pattern of hepatic enhancement. The occluded compartment, which was the drainage territory of the occluded hepatic vein, showed high attenuation in the early arterial phase and low attenuation in the portal phase. The adjacent compartment, which shared the same portal vein with the occluded compartment and was drained by the patent hepatic vein adjacent to the occluded one, showed strong contrast enhancement in the late arterial and early portal phase. Spiral CT and hepatic arteriography demonstrated the arterioportal shunt and reversed portal venous flow in the occluded compartment, which drained into the adjacent compartment. Conclusion: Acute hepatic vein occlusion on spiral CT appears as mild, early arterial, high attenuation and portal low attenuation of the occluded compartment and strong enhancement in the late arterial and early portal phases of the adjacent compartment due to arterioportal shunt and reversed portal flow. Received: 15 March 2001/Revision accepted: 4 July 2001     

Thrombectomy of portal vein thrombosis in living donor liver transplantation

We describe a case of living donor liver transplantation where an intrahepatic portal vein embolism was detected by intraoperative ultrasonography after the completion of portal and arterial anastomoses. The recipient portal vein trunk was clamped and the ligature of the graft's right portal branch was released, thus maintaining the sole arterial supply. Backward flushing of the portal system was achieved, which removed the clot through the reopened right portal branch without the need for thrombectomy by Fogarty balloon catheter.     

IVC anomalies and right renal aplasia detected on CT: a possible link?

Background: We report the occurrence of congenital anomalies of the inferior vena cava (IVC) and right renal aplasia in three patients as detected on computed tomography (CT). Methods: The medical records and imaging studies of three patients with congenital anomalies of the IVC and right renal aplasia were studied. We also reviewed eight reported cases with such an association. Results: Eleven patients, nine adults and two girls, were included in the series. Indications for imaging included deep vein thrombosis (n = 5), hypertension (n = 2), failure to advance a femoral vein catheter cranially (n = 1), dilated veins along the abdominal wall (n = 1), endstage renal failure (n = 1), and jaundice (n = 1). CT was performed in seven patients, and venography, aortography, and other imaging modalities were performed in four. IVC anomalies included partial or complete absence of the IVC in nine patients and a double vena cava in two. The azygos vein was very prominent in all patients in whom the IVC was absent. The right kidney was absent or very small in all patients. Conclusion: The association between IVC anomalies and absence of the right kidney as detected on CT probably was not incidental. Although most patients had symptoms deriving from the anomalies, these might have been clinically silent. The radiologist should be aware of the possible association between these anomalies, which can be detected on CT.     

Large extrahepatic portosystemic shunt without portal hypertension

Extrahepatic portosystemic shunt usually occurs secondary to severe portal hypertension, and it is rare to encounter it in patients without portal hypertension. We report herein a large extrahepatic portosystemic shunt between the left gastric vein and left renal vein without portal hypertension in which color Doppler sonography was useful not only for detection but evaluation of the effect of embolization. Received: 11 April 1995/Accepted: 26 July 1995     

Spiral CT virtual endoscopy of abdominal arteries: clinical applications

Virtual endoscopy enables the creation of endoluminal views of the aorta and its branches by processing spiral computed tomographic (CT) images, thereby allowing the preoperative and postoperative evaluations of abdominal aortic aneurysms, aneurysms of the splenic, celiac, and common iliac arteries, and renal artery stenoses. Moreover, it is helpful for verifying the position of stents and endoprostheses from within the aortic lumen. This method is a promising addition to spiral CT. Received: 3 May 1999/Accepted: 2 June 1999     

Renal lymphangiectasia: radiologic diagnosis and evolution

Renal lymphangiectasia is a rare renal entity. Symptoms and radiologic findings are well defined, but its clinical evolution is not totally well known. We report a severe case of renal lymphangiectasia with a large right perirenal collection and ascites. Both resolved 6 years later on computed tomography, but right intrarenal involvement worsened. To our knowledge, this form of evolution has not been described.     

Arterial embolization to control renal hemorrhage in patients with percutaneous nephrostomy

Two patients with renal hemorrhage treated by arterial embolization are reported. In one patient, one kidney was injured and the another had poor function. The other patient had one kidney. Although both patients had hematuria and underwent percutaneous nephrostomy, the bleeding location was not detected angiographically. Repeated embolization and irrigations through a nephrostomy catheter following each embolization arrested the bleeding. Received: 28 April 1995/Accepted: 2 June 1995     

肠系膜上动脉方位与胡桃夹现象的体位关系

目的 分析胡桃夹现象(NCP)患者肠系膜上动脉(SMA)方位与体位的关系,探讨体位疗法对NCP的治疗作用. 方法 46例NCP患者,根据SMA的不同方位分为正前位、左前位、右前位3组,并对各组病例进行平卧位、左侧卧位、右侧卧位,前倾位和直立位的左肾静脉超声检查,对每组各种体位超声测值进行比较. 结果 各组患者直立位NCP均加重,前倾位均减轻.左前位组左侧卧位减轻,右前位组右侧卧位减轻. 结论 SMA方位与不同体位NCP缓解有关.多体位超声检查对制定个体化的体位治疗方案具有重要意义.