Sonographic differentiation between the umbilical portion of the left portal vein and intrahepatic bile ducts

The method of differentiating between the portal vein and the bile ducts by means of their intrahepatic portions was studied. The left branch of the portal vein courses horizontally as the transverse portion, then veers anteriorly at an acute angle to make the umbilical portion. This characteristic form was demonstrated in all normal controls and 95% of the jaundiced patients studied. The left hepatic duct does not curve anteriorly at an acute angle, but branches off to the lateral segment running superior to the umbilical portion. This anatomic relationship and characteristic form of the umbilical portion were useful in differentiating the portal vein and the bile ducts.     

Prenatal diagnosis of total anomalous pulmonary venous connection to the portal vein associated with right atrial isomerism.

We report the prenatal diagnosis of total anomalous pulmonary venous connection to the portal system in a 20-week fetus with right atrial isomerism. The apex of the fetal heart pointed to the left, the fetal stomach was on the right, there was a common atrioventricular valve, the left ventricle was small and the abdominal aorta and inferior vena cava were on the left side; all these features were suggestive of right atrial isomerism. An anomalous vein was connected to the portal vein which ascended above the diaphragm and ended in a confluence of pulmonary veins, posterior to the common atrium. Color Doppler imaging helped confirm the diagnosis of total anomalous pulmonary venous connection. The prenatal findings were confirmed on autopsy.     

An unusual presentation of portal vein thrombosis in a 2-year-old girl

Portal vein thrombosis (PVT) is the most common cause of extrahepatic portal vein obstruction in children. Upper gastrointestinal (GI) bleeding and splenomegaly are the most common presenting features. PVT diagnosis is usually delayed in the absence of upper GI bleeding and many children undergo a hematologic work-up due to splenomegaly and signs of hypersplenism. Here, we present a case of a 2-year-old girl who had pancytopenia and splenomegaly. The hematologic work-up including a bone marrow aspirate was unrevealing and she was thought to have viral-induced bone marrow suppression and severe iron deficiency anemia. She presented 2 months later with hematemesis and abdominal CT angiography confirmed the diagnosis of PVT with portal cavernoma. Conclusion: PVT should be suspected in any child who presents with afebrile splenomegaly and signs of hypersplenism even in the absence of upper GI bleeding.     

Spontaneous rupture and thrombosis of an intrahepatic portal vein aneurysm

Aneurysm of the portal venous system, a localized fusiform or saccular dilatation, is a rare clinical abnormality. Most aneurysms are located in the extrahepatic segment and rarely in intrahepatic branches. Portal vein aneurysms are usually uncomplicated and asymptomatic and detected incidentally during diagnostic work-up. We describe a case of a bleeding intrahepatic portal vein aneurysm studied with ultrasonography, color Doppler, computed tomography, and percutaneous transhepatic portography in a noncirrhotic patient. Although there are 43 published cases of portal vein aneurysm in the English-language literature, neither rupture and spontaneous thrombosis of an intrahepatic portal vein aneurysm nor its nonsurgical conservative treatment has been reported.     

Splenic vein aneurysm with calcification of splenic and portal veins

Splenic vein aneurysm is a rare disease, and calcifications in the portal venous system are also rare. Here we present a case of splenic vein aneurysm associated with calcification of the splenic and portal veins, a condition that to our knowledge has not been reported before.     

门静脉海绵样变性左支分流手术前后的超声应用

目的探讨超声评估门静脉海绵样变性合并门静脉高压症患儿门静脉左支分流手术（Rex手术）疗效的价值。方法选取2014年10月~2016年1月在我院因门静脉海绵样变性合并门静脉高压症行Rex手术的患儿10例,手术前、后二维超声分别测量肝脏、脾脏各个径线值并计算其大小变化,测量手术前后门静脉左支、术后桥血管及吻合口内径,多普勒超声评价门静脉左支、桥血管及吻合口的血流通畅情况。结果10例患儿Rex术后门静脉海绵样变性病变区域血流信号显著减少;术前肝右叶斜径、肝左叶上下径、脾脏面积分别为98.5±3.5 mm、53.3±2.7 mm、42.9±5.9 cm2,其中,术后1周的肝右叶斜径（109.3±1.9 mm）以及术后1年的肝右叶斜径（108.7±1.0 mm）、左叶上下径（64.0±2.5 mm）、脾脏面积（28.5±3.6 cm2）较术前的差异均有统计学意义（P<0.05）。术后门静脉左支、门静脉左支吻合口超声显示清晰,显示率为100%,肠系膜上静脉吻合口显示率为70%。术前门静脉左支内径为2.58±0.34 mm,术后门静脉左支内径为5.33±0.61 mm（术后6月）、6.90±0.95 mm（术后1年）,较术前差异均有统计学意义（P<0.05）;术后1周、3月、6月、1年的相关血管内径如下:桥血管:5.96±0.80、6.90±0.68、7.41±0.56 mm;门静脉左支吻合口:2.77±0.37、2.71±0.36、3.53±0.32 mm;肠系膜上静脉吻合口:3.26±0.16、3.40±0.17、3.63±0.11 mm。结论超声可无创、定量评估Rex手术前后肝脏和脾脏大小、门静脉左支,术后桥血管、吻合口内径,评估术后门静脉左支、桥血管及吻合口的血流状态,为手术效果的评估提供可靠指标。      

TIPSS术后肝性脑病的发生与门静脉血流方向的关系—附212例分析

目的研究经颈静脉途径肝内门-体静脉内支架分流术(TIPSS)术后肝性脑病的发生与门静脉血流方向的关系.方法采用彩色多普勒超声测量212例TIPSS术后患者的肝内门静脉血流.结果212例TIPSS术后病人发生肝性脑病33例,占16%;门静脉血流方向呈离肝型的病人的肝性脑病发生率较呈向肝型的病人高(60%比3%,P＜0.02).结论TIPSS术后门静脉血流方向呈离肝型者容易发生肝性脑病;彩色多普勒超声可作为监测TIPSS术后肝性脑病的方法之一.     

Clinical efficacy of transjugular intrahepatic portosystemic shunt created through left or right branches of the portal vein: A meta-analysis

Background and aimTransjugular intrahepatic portosystemic shunt (TIPS) is a technique successfully used to treat portal hypertension and its complications. However, the choice of the branch, left (L) or right (R), of the portal vein resulting in a better outcome is still under debate. Therefore, this meta-analysis aims to evaluate which branch has a better curative effect on patients treated with TIPS.MethodsPubMed, EMBASE, Web of science, Cochrane Library databases, Wanfang database and CBM were used for our search in October 2019 and updated in June 2021. The following parameters were used in evaluation: overall mortality, hepatic encephalopathy, shunt dysfunction, variceal rebleeding and rate of postoperative ascites.ResultsThere were seven studies included. The sample size was 1940. A lower risk of mortality was observed in TIPS-L-treated patients compared with TIPS-R-treated ones (OR ​= ​0.65, 95% CI ​= ​0.50–0.85, p ​= ​0.002). A lower risk of shunt dysfunction was observed in TIPS-L-treated patients compared with TIPS-R-treated ones (OR ​= ​0.53, 95% CI ​= ​0.33–0.87, p ​= ​0.01). And the TIPS-L group had a significantly higher hepatic encephalopathy-free rate than the TIPS-R group (OR ​= ​0.59, 95% CI ​= ​0.44–0.78, p ​= ​0.0002). However, the rate of rebleeding (OR ​= ​0.75, 95% CI ​= ​0.55–1.03, p ​= ​0.07) and incidence of postoperative ascites (OR ​= ​1.14, 95% CI ​= ​0.86–1.51, p ​= ​0.38) was not statistically significant between the two groups.ConclusionsBased on the currently available evidence, the technique of TIPS through the left branch of the portal vein can significantly reduce the occurrence of overall postoperative mortality, hepatic encephalopathy and shunt dysfunction.     

To-and-fro waveforms in the left gastric vein in portal hypertension

Unusual to-and-fro waveforms were demonstrated in the left gastric vein on Doppler sonograms in four patients with liver cirrhosis. The patterns of the to-and-fro waveforms were diverse in each of the patients: both hepatopetal and hepatofugal flow occurred in a single waveform in case 1, changes in the flow direction with flow interruption were noted in case 2, and changes in flow direction without observation of flow interruption and changes after meals were noted in cases 3 and 4, respectively. These waveforms may represent a transitional phase during the development of a portal systemic shunt in patients with portal hypertension.     

冠状动脉旁路移植术中与术后左内乳动脉桥血流对比分析

目的　为评估冠状动脉旁路移植术 (CABG)后患者内乳动脉桥的血流状态探索一种有效、安全及简便的检查方法。方法　对CABG术后 3 6例患者 (据左前降支狭窄程度分为两组 :1组 ,狭窄≥ 90 % ;2组 ,狭窄 <90 % )进行经胸多普勒超声检查 ,测定左内乳动脉 -前降支 (LIMA -LAD)血管桥的各项血流参数并计算出收缩期血流量、舒张期血流量和平均血流量 ,与术中即时超声血流探测仪TTFM (transit-timeflowmeter)直接测量的LIMA -LAD血管桥各期血流量分析比较。结果　①LIMA -LAD血管桥术中经TTFM检测及术后经胸多普勒超声检测 ,其舒张期血流量与舒张期血流量 收缩期血流量比值相关性较好 (r值分别为 0 .67,0 .78) ;②组间舒张期血流量 收缩期血流量比值的差异有显著性(术中P =0 .0 0 0 ;术后P =0 .0 3 8)。结论　①经胸多普勒超声可作为CABG术后检测LIMA -LAD血管桥血流特征的一项有实用价值的检测技术 ;②CABG术前前降支狭窄越重 ,CABG术后LIMA -LAD血管桥的冠状动脉血流特征越明显