Long-term effect of lipid-lowering therapy on atherosclerosis of abdominal aorta in patients with hypercholesterolemia: noninvasive evaluation by a new image analysis program

Recent clinical studies have demonstrated that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are effective in the prevention of cardiovascular events and regression of atherosclerotic lesions evaluated by angiography. In this study, the authors investigated how lipid-lowering therapy effects on the progression of aortic atherosclerosis by using plain and enhanced computed tomography (CT) of the lower abdominal aorta. Twenty-nine hyperlipidemic patients (mean age 61.4 +/- 7.2 yr) were enrolled in a prospective open-labeled study. All patients underwent baseline CT scanning of abdominal aorta, screening for serum lipid profile and coagulation-fibrinolysis measurement, then treatment with simvastatin was begun. After 2 years, a follow-up CT scan was done and atherosclerotic lesions were compared between baseline and on-treatment scan. In spite of significant improvement of lipid and fibrinolytic profiles by simvastatin administration, mean aortic wall thickening volume (AWV) was increased during observation period. When patients were divided into subgroups by the levels of on-treatment LDL cholesterol (LDL-C), development rate of AWV was more potently suppressed in patients whose on-treatment LDL-C were below 125 mg/dL (median LDL-C). We could not find any associations of coagulation-fibrinolysis measurements with atherosclerotic lesions. In regard to aortic calcification volume (ACV), low levels of total and HDL cholesterol and higher age were associated with aortic calcification at baseline. These results suggest that aggressive treatment with LDL-C below 125 mg/dL may suppress the progression of wall thickening and factors that promote arterial calcifications and those for wall thickening may be different.     

Three-dimensional CT angiography with volume rendering for the dignosis of multiple intracranial aneurysms

Objective: To evaluate the importance of 3D-CTA with volume rendering for the diagnosis of multiple intracranial aneurysms. Methods: Axial source images were obtained by helical CT scanning and reconstruction of 3D-CTA images was done by volume rendering technique in conjunction with muhiplanar reformation. Results: In the past one year, there were 10 patients diagnosed as having multiple intracranial aneurysms by 3D-CTA and altogether 24 aneurysms were visualized, including 10 small aneurysms (≤5mm. Three-dlmenslonal CT angiography with volume rendering demonstrated aneurysms very well and provided useful information concerning the site, shape, size and spatial relationship with the surrounding vessels and bone anatomy. Conclusion: Three-dimensional CT angiography with volume rendering is a quick, reliable, and relatively noninvasive method for diagnosing multiple intracranial aneurysms. It delineates detailed aneurysmal morphology, and provides useful information for planning microsurgical approaches.     

Usefulness of ultrasonography in carotid arteries and combined positron emission tomography/ computed tomography for diagnosis of Takayasu arteritis with unusual presentation as acute myocardial infarction: a case report

This unusual case of Takayasu arteritis presenting as acute myocardial infarction could be defined by ultrasonography and 18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) coregistered with computed tomography (CT). A 55-year-old male was admitted to our hospital with continuous chest pain and left-side neck pain. After primary percutaneous coronary intervention, elevation of inflammatory markers persisted and dull pain in the left side of the neck continued. Ultrasonography revealed characteristic wall thickening of the left common carotid artery and subsequent 18F-FDG PET with CT depicted positive uptake in the left common carotid artery and the vessel wall of the ascending aorta, confirming the diagnosis of Takayasu arteritis. Three months after angioplasty, follow-up cardiac catheterization was performed. Coronary angiography showed no restenosis. During the catheterization, angiography confirmed the mild stenosis in the long segment of the left common carotid artery and the left subclavian artery as well as the focal narrowing and the dilation of the abdominal aorta. This case shows that ultrasonography in the cervical region and combined 18F-FDG PET with CT may be useful in the diagnosis and evaluation of Takayasu arteritis. In addition, we should pay attention to underlying disease even in middle-aged or older male patients with acute myocardial infarction.     

CT平扫对结核性腹膜炎的诊断价值

目的 探讨结核性腹膜炎的CT平扫表现特征。方法 回顾性分析46例有CT扫描资料的结核性腹膜炎患者,其中经手术病理证实6例,腹腔穿刺证实2例,腹腔镜检证实4例,试验性治疗诊断34例。观察内容包括结核性腹膜炎累及壁腹膜、大网膜、肠系膜及腹膜后间隙的CT表现特征。结果 （1）壁腹膜增厚33例,其中均匀、光滑增厚27例,局部不规则增厚6例;（2）腹腔积液31例,其中20例为少量积液;（3）大网膜增厚26例,表现为污迹样增厚22例,饼状增厚2例;（4）肠系膜受累32例,其中9例合并小结节影：（5）淋巴结增大16例;（6）肠壁增厚1例,肠间距增宽2例。结论 结核性腹膜炎CT平扫的主要表现有少量腹腔积液、均匀性腹膜增厚、大网膜污迹样增厚,以及肠系膜、肠管受累与腹腔淋巴结增大,CT平扫能为结核性腹膜炎的诊断提供重要信息。     

A case of colon obstruction developed as a complication of acute pancreatitis]

In acute pancreatitis, colonic complications such as mechanical obstruction, ischemic necrosis, hemorrhage, and fistula are rare but their outcomes are fatal. It is known that colonic obstruction in acute pancreatitis is more likely found in splenic flexure and transverse colon caused by severe inflammation of body and tail of pancreas leading to pressure necrosis. A 43-year-old man presented with abdominal distension lasting for 2 weeks. The patient had been admitted to our institution 6 weeks prior to the current admission, and the abdominal CT scan performed during the first admission revealed the pancreatic enlargement with peri-pancreatic fatty infiltration and fluid collection. At that time he was diagnosed as acute pancreatitis. The conservative management resulted in clinical improvement so that the patient was discharged. Upon the second admission, abdominal CT scan revealed multiple pseudocysts in the tail portion of pancreas with concominant wall thickening and narrowing of the proximal descending colon, and a dilatation of the bowel proximal to the splenic flexure. An obstruction of the descending colon as a complication of acute pancreatitis was suspected and the patient underwent left hemicolectomy. Abdominal distension was relieved after the operation and he was discharged on the 15th hospital days.     

A successful case of varix of the left gastroepiploic vein preoperatively diagnosed by 3D-CT angiography and resected by laparoscopy: A case report

Introduction:Gastric varices can be present in up to 20% of patients with portal hypertension. However, a varix of the left gastroepiploic vein (LGV) is extremely rare. Surgery is required if bleeding occurs; thus, precise diagnosis is crucial. We present a successful case of preoperative diagnosis intraabdominal varix of the LGV using three-dimensional-computed tomography angiography (3D-CTA) followed by laparoscopic resection. This is the first report of a case with variant LGV. Our study demonstrates the efficacies of 3D-CTA and laparoscopic surgery for the diagnosis and safe resection of the intraabdominal varix, respectively.Patient concerns:A 74-year-old woman was referred to our department with a tumor in the abdominal cavity. On physical examination, no lumps were palpable in the upper abdomen.Diagnosis:The enhanced CT was revealed that the tumor was not enhanced in the early phase, but in the equilibrium phase. Moreover, 3D-CTA clearly revealed that the tumor was being supplied by the LGV. Thus, it was diagnosed as a variant of the LGV.Interventions:Surgical resection was performed laparoscopically as per the guidance of preoperative 3D-CTA findings. During surgery, a dark tumor was found along the gastroepiploic vessels, supplied by the LGV. The tumor was resected safely based on the preoperative information.Outcomes:Histopathological examination of the tumor showed accumulation of various vessels, but no malignant cells. Therefore, we made a final diagnosis of the tumor as an LGV varix. For follow-up, an annual CT examination was performed and after 3 years postoperation, no recurrence was observed.Conclusions:In the present case, we have achieved a successful preoperative diagnosis using 3D-CTA, and resection was safely accomplished using laparoscopy guided by preoperative anatomical information. This is the first report of an LGV variant. Appropriate management is crucial because bleeding is a catastrophic event. Therefore, imaging procedures such as 3D-CTA for diagnosis, followed by safe resection by laparoscopic surgery, are effective tools for the treatment of epiploic vein varices.     

Amyloidosis of the colon presenting as ischemic colitis: a case report and review of the literature

Review of the English literature revealed 21 cases describing abnormalities on barium enema secondary to amyloidosis of the colon. These cases were categorized as to frequency of specific barium enema findings and distribution within the colon. The most common radiologic findings were luminal narrowing (11 of 21), loss of haustrations (10 of 21), thickened mucosal folds (8 of 21), mucosal nodularity (8 of 21), and ulceration (6 of 21). The most frequent locations of disease within the colon were the descending and rectosigmoid portions (13 of 21). We present a case of primary amyloidosis that demonstrates the findings of bowel wall thickening and luminal narrowing on double-contrast barium enema and computed tomography (CT). Pathologic examination in our case, in addition to similar observations from the literature, suggests that at least a part of the radiologic changes of colonic amyloid can be attributed to bowel ischemia.     

Mucormycosis of the central airways: CT findings in three patients.

Computed tomographic (CT) findings are described in three diabetic patients with central airways mucormycosis. The CT findings of the tracheobronchial mucormycosis include enhancing areas of mural thickening (n = 3), luminal narrowing (n = 3), intramural air (n = 3), low-attenuation nonenhancing bronchial wall thickening (n = 2), and bronchonodal fistula formation (n = 1). These CT features in a diabetic patient should raise a high index of suspicion for tracheobronchial mucormycosis, particularly when typical radiographic features of pulmonary tuberculosis are absent.     

Xanthogranulomatous cholecystitis: the use of preoperative CT findings to differentiate it from gallbladder carcinoma

Background and aim

A retrospective analysis was performed on 32 patients with histologically confirmed xanthogranulomatous cholecystitis (XGC) and 21 patients with gallbladder carcinoma who underwent surgical treatment between 1998 and 2007.

Methods

All patients underwent preoperative CT scanning. The CT features analyzed were: the presence of intramural hypoattenuated nodules or bands, mucosal line, the patterns of wall thickening and enhancement, and the presence of stones in the gallbladder. The variables of the CT findings with XGC were analyzed using multivariate logistic regression analysis.

Results

Intramural hypoattenuated nodules were observed in 21 patients (65%) with XGC, but in only six patients (29%) with gallbladder carcinoma (P < 0.01). The mucosal line was observed in 27 patients (84%) with XGC and in only four patients (19%) with gallbladder carcinoma (P < 0.0001). Gallstones were noted in 24 patients (75%) with XGC and five patients (24%) with gallbladder carcinoma (P < 0.001). There was no significant difference in the pattern of gallbladder wall thickening (diffuse or focal) and the presence of changes outside the gallbladder. Multivariate logistic regression analysis revealed from the CT features that the enhanced continuous mucosal line (P = 0.0013) and the presence of gallstones (P = 0.0072) were independently correlated with XGC.

Conclusion

CT features of the enhanced continuous mucosal line in a thickened gallbladder wall, together with gallstones in a patient with chronic gallbladder disease, are highly suggestive of XGC. Accurate diagnosis of XGC may therefore indicate the need to select a less aggressive surgical approach.     

Dynamic helical biphasic CT emerges as a potential tool for the diagnosis of proximal arterioportal shunting.

BACKGROUND/AIMS: This article reports our preliminary observation regarding the diagnostic ability of dynamic helical biphasic computed tomography (CT) for proximal arterioportal shunting in hepatoma patients as compared with that of conventional angiography. METHODOLOGY: Three hundred and sixty patients with clinically-suspected liver lesions received both dynamic helical biphasic CT scan and conventional angiography of the liver. The criteria for diagnosis of proximal arterioportal (AP) shunting in dynamic helical biphasic CT included early and strong enhancement of main portal vein or its major branches approaching the density of the aorta, or enhancement of the portal vein earlier than opacification of the splenic vein and superior mesenteric vein in the arterial phase. The angiographic diagnosis of proximal AP shunting was made if there was early opacification of the main portal vein or its major branches in the arterial phase. Peripheral subsegmental small AP shunting was excluded from our study. The existence and extent of AP shunting were compared in these two imaging modalities. RESULTS: Dynamic helical biphasic CT scan demonstrated proximal AP shunting in 23 patients. All of these patients harbored hepatoma. Conventional angiography showed proximal AP shunting in 20 patients, which were all positive on dynamic helical CT. Dynamic helical biphasic CT demonstrated the presence of proximal AP shunting in 3 more patients than conventional angiography did. The extent of AP shunting was well correlated between these two imaging modalities in 17 patients. CONCLUSIONS: From our preliminary experience, the diagnostic accuracy of dynamic helical biphasic CT for proximal AP shunting in patients with hepatoma seemed to be comparable to, or even surpassed that of conventional angiography. It seems that faint AP shunting in patients with large hepatoma might be missed by conventional angiography.     

Clinical significance of incidentally detected bowel wall thickening on abdominal computerized tomography scan]

BACKGROUND/AIMS: Due to widespread use of computerized tomography (CT) scan to examine patients with variable disease or complaints, detection of incidental or unsuspected gastrointestinal abnormalities are not uncommon. Clinical significance of incidentally detected bowel wall thickening (BWT) on abdominal CT scan is uncertain at present. Despite the necessity for the clinical guidelines describing the evaluation of incidental bowel wall thickening on CT scan, there have been few studies concerning these radiological abnormalities. Our objective was to determine whether endoscopic evaluation is necessary for the evaluation of these abnormal findings. METHODS: This study evaluated one hundred and forty patients with incidentally detected BWT on abdominal CT scan in Inje University Sanggye Paik Hospital from 2001 to 2003. 102 patients of those were proceeded by endoscopic evaluation. Forty-eight patients had received upper endoscopy, 26 patients had colonoscopy, while 28 patients had sigmoidoscopy. RESULTS: Endoscopic work up revealed significant abnormalities in 83% of patients with incidental findings of the distal esophagus, 73% of patients with thickening of the stomach, 35% of patients with thickening of the right colon, and 71% of patients with thickening of the sigmoid colon and rectum. CONCLUSIONS: Although significant pathologic findings are less common in thickening of the right colon than other bowel wall thickening, all of these incidental findings on CT scan warrant further endoscopic evaluation.     

Lipoma of the small bowel

CLINICAL FEATURES: A 40-year-old female presented with chronic diarrhoea, intermittent abdominal pain, and melena. She reported of a 7 kg loss of weight within the preceding 6 weeks and showed signs of mild abdominal pain upon palpation of the right lower quadrant. Our clinical diagnosis was Crohn's disease or infectious gastro-enteritis as a CT scan showed thickening of the colonic wall in the right lower quadrant. However a previously performed ileocolonoscopy was normal. TECHNICAL EXAMINATIONS: Magnetic resonance imaging showed a thickened terminal ileum with extensive narrowing of the bowel lumen, in addition a polyp obstructing the lumen of the terminal ileum at 30 cm was detected during colonoscopy. THERAPY: The involved portion of ileum was resected. Intraoperatively an intussusception with the polyp forming the leading edge was found. Histological analysis led to the diagnosis "lipoma". Postoperatively the patient is now feeling well without any abdominal pain. CONCLUSION: Tumours of the small bowel are rare and are therefore often forgotten in the list of differential diagnoses of abdominal pain. If symptomatic, these tumours present mainly with uncharacteristic and unspecific signs, often leading to a delay in correct diagnosis as in the presented case. We therefore suggest that small bowel tumours should be considered at earlier stages in the differential diagnosis of unexplained abdominal pain in the middle-aged patient with signs of intestinal obstruction.     

CT diagnosis of complete tracheal rings in an adult

We report a case of complete tracheal rings diagnosed by computed tomography (CT) in a 34-year-old woman with history of congenital heart disease who presented with long-standing shortness of breath and chest tightness. CT of the trachea revealed concentric narrowing of the distal trachea, with an "O"-shaped lumen and absence of wall thickening. Virtual endoscopic CT images showed concentric rings at the site of stenosis, consistent with complete tracheal rings, which were confirmed by conventional bronchoscopy. To our knowledge, the CT findings of this condition have not been previously described. CT with 3-dimensional reconstructions has the potential to noninvasively aid in the diagnosis and monitoring of patients with this condition.     

Clinical utility of computed tomographic scanning for the evaluation of lupus profundus in two patients with systemic lupus erythematosus

Lupus profundus is a rare lupus-specific skin lesion with skin biopsies exhibiting lobular lymphocytic infiltration and destruction of subcutaneous fat tissue. In this report, a CT scan was effective in demonstrating both the presence and the extent of inflammation of lupus profundus in two patients with systemic lupus erythematosus (SLE). Case 1 was a 30-year-old woman developing erythema with subcutaneous induration on the upper arms during the quiescent phase of SLE. A skin biopsy confirmed a diagnosis of lupus profundus. A CT scan of the right upper arm demonstrated a high density area (HDA) of the subcutis under the erythema: a finding consistent with lupus profundus. Case 2 was a 28-year-old woman recently diagnosed with SLE. She also developed a skin ulcer on the right hip. A CT scan of the hip revealed an HDA and lipoatrophy of the subcutis around the ulcer: these findings were compatible with lupus profundus. Treatment with high-dose prednisolone improved the illness in the both cases. A CT scan is a useful and convenient imaging modality for confirming the diagnosis of lupus profundus.     

320排容积CT对胡桃夹综合征的诊断和辐射剂量评价

目的探讨320排容积CT诊断胡桃夹综合征的应用价值。方法对8例胡桃夹综合症的患者行双肾动脉晚期320排容积扫描,检查床处于静止状态,球管旋转一圈,扫描范围为16cm。30例其它病变患者作为对照组行64排螺旋扫描。通过多重加权CT齐0量指数计算出剂量长度乘积（DIJP）值,有效辐射剂量通过DLP值及转换系数（0．015）获得,对CT容积扫描与64~CT的有效剂量进行对比。结果320排容积成像能清晰、直观显示左肾静脉（LRV）的形态及立体走形,8例患者的肠系膜上动脉（SMA）与腹主动脉（AA）之间的夹角平均22．60°±7．30°,且出现LRV不同程度受压,近端扩张;对照组30例,SMA与AA之间的夹角平均58．3°±26．20°。病变组单期扫描的有效剂量为2．6mSv,对照组的有效剂量为4．9mSv。结论320排容积CT明显的缩短了扫描时间,辐射剂量明显低于对照组,通过后处理清楚显示AA、LRV及脊柱三者空间结构及立体走向,与多排CT相比,对胡桃夹综合征的诊断具有明显的优势。     

Angiotensin-Ⅱ administration is useful for the detection of liver metastasis from pancreatic cancer during pharmacoangiographic computed tomography

AIM: To improve the preoperative diagnosis of liver metastasis from pancreatic cancer, we estimated computed tomography during arterial angiography (CTA) with/without administration of angiotensin-Ⅱ (AT-Ⅱ). METHODS: Thirty-fi ve patients with pancreatic cancer were examined in this study. After conventional CTA was performed, pharmacoangiographic CTA was performed with a 1-3 microgram/5 mL solution of angiotensin Ⅱ injected through a catheter into the celiac artery during spiral computed tomography. We prospectively analyzed the relative region of interest (ROI) ratio of tumor to liver with/without AT-Ⅱ. RESULTS: In all patients, the relative ratio of each computed tomography (CT) number in the ROI was larger at pharmacoangiographic CT than at conventional angiographic CT. Administration of angiotensin-Ⅱ enhanced the metastatic liver tumor as compared with normal tissue. Intratumoral blood flow increased in all patients with malignant tumors due to the pressure effect of AT-Ⅱ. Furthermore, the metastatic lesions in the liver of three patients were represented by only pharmacoangiographic CT, not by conventional CT and conventional CT angiography. In even peripheral and central areas of metastatic liver tumor, the lesions were enhanced after administration of AT-Ⅱ. CONCLUSION: These results support that high detection rate of liver metastasis revealed by pharmacoangiographic CT suggests the improvement of diagnosis on preoperative staging. Moreover, chemotherapy under AT-Ⅱ induced hypertension may have a better effect on the treatment of metastatic liver tumors.     

增强CT扫描及后处理技术对肺隔离症的诊断价值

目的探讨增强CT扫描及其后处理技术在肺隔离症中的诊断价值。方法回顾分析18例经手术和病理证实的肺隔离症患者胸部增强CT及后处理图像。结果其中叶内型16例(89%),叶外型2例(11%);14例位于左下肺(78%),4例位于右肺(22%);实性肿块3例,囊实性肿块11例,囊性病灶1例,血管增粗及条索影3例;供血动脉2例来自腹主动脉上段,另外16例来自胸主动脉下段,其中多支供血动脉3例,单支供血动脉15例,16例引流至同侧肺静脉,1例引流至半奇静脉,1例为双重静脉引流(肺静脉、奇静脉);18例均能完整地显示异常供血动脉及引流静脉的全貌。结论增强CT扫描及其后处理技术能清晰显示病灶内异常供血动脉及引流静脉,对肺隔离症的诊断具有重要的临床应用价值,可以取代血管造影作为诊断该病的最佳检查方法。     

CT平扫及增强联合多模式重建技术用于结肠肿瘤病变的诊断价值

目的探讨CT平扫及增强扫描联合多模式重建技术用于结肠肿瘤病变的诊断价值。 方法回顾性分析广安市人民医院行肠镜检查怀疑为结肠病变的96例患者的临床资料,术后均经病理证实为结肠癌70例,结肠息肉26例,所有患者术前经CT平扫及增强扫描,并将扫描数据传入后处理工作站,获取多平面重建（MPR）、透明法（Raysum）及结肠仿真内镜（CTVC）图像,分析结肠癌CT表现,对结肠癌术前CT图像进行T、N分期,并与术后病理结果进行比较。 结果CT平扫及增强扫描联合多模式重建技术对结肠癌病变检出率、结肠息肉检出率均为100.00%。CT平扫及增强扫描联合多模式重建技术诊断累及浆膜层、累及邻近组织脏器、腹膜后淋巴结转移与病理结果比较差异均无统计学意义（P>0.05）。术前CT平扫及增强扫描联合多模式重建技术诊断T分期总准确度为84.29%,≤T₂期、T₃期、T₄期准确度分别为75.00%、73.33%、88.10%;诊断N分期总准确度为71.43%,N₀期、N₁期、N₂期准确度分别为72.73%、60.00%、77.27%。术前CT平扫及增强扫描联合多模式重建技术诊断T、N分期与病理诊断T、N分期一致性好（Kappa=0.725,0.547,均P<0.05）。 结论CT平扫及增强扫描联合多模式重建技术对结肠肿瘤病变诊断准确率高,可较好的显示结肠癌肠腔情况,明确肿瘤侵犯范围及腹膜后淋巴结转移情况,还可用于术前分期诊断,临床应用价值较高。     

CT肺动脉及支气管动脉联合造影对咯血患者的诊断价值

目的 探讨建立CT肺动脉(PA)及支气管动脉(BA)联合造影的方法及其对咯血患者的诊断价值.方法 连续纳入北京朝阳医院2007年6月至2009年7月36例中等量及以上咯血住院患者,其中男21例,女5例,年龄27 ～ 83岁,平均(56±14)岁.使用16排螺旋CT,静脉注射对比剂后,首先完成CT肺动脉造影(CTPA),延迟时间12～16 s,继之完成CT支气管动脉造影(CTBA),延迟时间26～28 s,经图像重建后对PA及BA进行评价.结果 36例患者CTPA检查发现7例PA异常(肺栓塞3例,PA畸形、原发性PA平滑肌肉瘤、PA边缘模糊及右下PA闭塞各1例).36例患者CTBA检查共显示37支右侧BA,其中11支迂曲增粗、40支左侧BA及3支非支气管体循环动脉,其中来源于腹主动脉的1支迂曲增粗.异常血管与肺部疾病关系密切.结论 利用16排螺旋CT技术,可进一步完成CTPA及CTBA检查,清楚显示异常的PA及BA,对咯血的诊断及治疗具有重要价值.     

A case of mesenteric venous thrombosis after endoscopic variceal band ligation

A rare case of isolated superior mesenteric venous thrombosis (MVT) after endoscopic variceal band ligation (EVL) is reported. A 64-year-old woman with a history of idiopathic portal hypertension presented at the emergency room with vomiting, increasing cramping abdominal pain, and low-grade fever. She had undergone EVL for esophageal varices 4 months before and had had intermittent attacks of mild abdominal pain after the EVL. Ultrasonogram of the abdomen demonstrated marked concentric wall thickening of the ileal loop. Enhanced computed tomographic (CT) scan revealed a central lucency in the lumen of the superior mesenteric vein, surrounded by a high-density vein wall, corresponding to a thrombus. An isolated MVT and venous collateral network in the splanchnic area were confirmed by angiography. Supportive therapy, i.e., water and electrolyte replacement, and anticoagulation improved the clinical condition and radiologic status. This case of MVT after EVL suggests a possible relationship between EVL and MVT. It is necessary for clinicians to be aware of this relationship for the early diagnosis of MVT.