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Gioia S, De Santis A, d'Amati G, Nardelli S, Spagnoli A, Rocco AD, Ridola L, Riggio O. Application of ultrasonography-elastography score to suspect porto-sinusoidal vascular disease in patients with portal vein thrombosis. Hepatobiliary Pancreat Dis Int 2024; 23:20-24. [PMID: 37468349 DOI: 10.1016/j.hbpd.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Porto-sinusoidal vascular disease (PSVD) and portal vein thrombosis (PVT) are causes of portal hypertension characterized respectively by an intrahepatic and a pre-hepatic obstacle to the flow in the portal system. As PVT may be a consequence of PSVD, in PVT patients at presentation, a pre-existing PSVD should be suspected. In these patients the identification of an underlying PSVD would have relevant implication regarding follow-up and therapeutic management, but it could be challenging. In this setting ultrasonography may be valuable in differential diagnosis. The aim of the study was to use ultrasonography to identify parameters to discriminate between PSVD and "pure" PVT and then to suspect PVT secondary to a pre-existing PSVD. METHODS Fifty-three patients with histologically proven PSVD and forty-eight patients affected by chronic PVT were enrolled and submitted to abdominal ultrasonography with elastography by acoustic radiation force impulse (ARFI). RESULTS ARFI was higher and superior mesenteric vein (SMV) diameter was wider in PSVD patients than in PVT patients. Thus, a prognostic score was obtained as linear combinations of the two parameters with a good discrimination capacity between PSVD and PVT (the area under the curve = 0.780; 95% confidence interval: 0.690-0.869). CONCLUSIONS A score based on ARFI and SMV diameter may be useful to suspect an underlying PSVD in patients with PVT and to identify a subgroup of patients to be submitted to liver biopsy.
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Affiliation(s)
- Stefania Gioia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Adriano De Santis
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia d'Amati
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Nardelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Arianna Di Rocco
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Ridola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Oliviero Riggio
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Tamiru R, Hailemariam T, Wakjira E, Hailu SS. Congenital extrahepatic portosystemic shunt masquerading as chronic portal vein thrombosis: A case report. Int J Surg Case Rep 2023; 109:108553. [PMID: 37481969 PMCID: PMC10391669 DOI: 10.1016/j.ijscr.2023.108553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Congenital extra hepatic portosystemic shunt (CEPS) is a rare vascular malformation in which splanchnic and portal blood is shunted into the systemic circulation eluding the liver. Type 1 CEPS is sometimes difficult to differentiate from pathologies such as chronic portal veinthrombosis as the portal vein may not be visualized in either entities. CASE PRESENTATION A 3-year-old male child with a week of abdominal pain was diagnosed with chronic portal vein thrombosis in an out-of-hospital setting. Repeat abdominal ultrasound was done at our institution and we were able to visualize termination of the portal vein to the suprarenal infra-hepatic inferior vena cava with an end to side pattern and a focal hypoechoic hepatic lesion at segment eight of the liver. There was no evidence of cavernous transformation or sign of portal hypertension. Subsequently, tri-phasic computed tomography revealed similar findings, with the portal vein terminating at the suprarenal inferior vena cava. The focal hepatic lesion showed peripheral contrast enhancement in the arterial phase and appeared as a central non-enhancing area with evidence of homogeneous enhancement on the subsequent sequences. CLINICAL DISCUSSION Type 1 CEPS can be easily confused with chronic portal vein thrombosis as the portal vein may not be visible and the hepatic artery shows compensatory enlargement in both entities. However, portal vein thrombosis is usually associated with underlying predisposing factors and can result in the development of secondary signs of portal hypertension and cavernous transformation which are critical to distinguish it from CEPS. CONCLUSION Chronic portal vein thrombosis is a great mimicker that should be distinguished from CEPS on ultrasound. A meticulous scan with color flow is helpful to scrutinize vascular anatomy, identify findings associated with CEPS such as hepatic lesions, and exclude signs of chronic portal vein thrombosis.
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Affiliation(s)
- Raja Tamiru
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Tesfahunegn Hailemariam
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia.
| | - Eyasu Wakjira
- Wudassie Diagnostic Center, Department of Radiology, Addis Ababa, Ethiopia
| | - Samuel Sisay Hailu
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
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Levigard RB, Salas H, Serrão H, Diniz F, Nogueira CAV, de Oliveira AA, Leite NC, Ladeira M, Chindamo MC, Pereira G. Liver Growth and Portal Hypertension Improvement After Percutaneous Recanalization of Chronic Portal Vein Thrombosis in Non-Cirrhotic Participants. Cardiovasc Intervent Radiol 2022; 45:582-589. [PMID: 35166884 DOI: 10.1007/s00270-022-03065-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/24/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate liver function improvement and volume gain after percutaneous recanalization of chronic portal vein thrombosis (PVT) in non-cirrhotic patients. MATERIALS AND METHODS In this retrospective study, five non-cirrhotic participants between 21 and 67 years old with secondary chronic PVT (4-21 years from diagnose) were submitted to percutaneous portal vein recanalization, followed by varices and shunts embolization. RESULTS After a mean of 12.6 months, all portal veins remained patent and there was complete resolution of portal hypertension (PH) symptoms in all participants. There was a significant increase in liver volume of 39.8 ± 19.0% (p = 0.042), platelets count of 53120 ± 20188/μl (p = 0.042), and a significant decrease in total bilirubin levels from 1.04 ± 0.23 mg/dL to 0.51 ± 0.09 mg/dL (p = 0.043). We also found a non-significant increase in albumin levels from 3.88 ± 0.39 g/dL to 4.38 ± 0.27 g/dL (p = 0.078) and decrease in spleen diameter from 16.88 ± 4.03 cm to 14.15 ± 2.72 cm (p = 0.068). DISCUSSION In this retrospective study, even with a small number of participants, we were capable of showing a median of 39.8% increase in liver volume, laboratorial liver function improvement, platelets count and resolution of PH symptoms, including gastroesophageal varices disappearance after portal vein recanalization followed by shunt embolization. CONCLUSION In this small series of cases, recanalization of chronic PVT in non-cirrhotic participants was feasible, successful and safe despite the prolonged time of occlusion. This is a new and promising approaching to an old and still challenging disease.
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Affiliation(s)
- Raphael Braz Levigard
- Interventional Radiology Department, Rede D' Or/São Luiz, Rua Real Grandeza 108, sala 113, Botafogo, Rio de Janeiro, RJ, 22281-034, Brazil.
| | - Henrique Salas
- Interventional Radiology Department, Rede D' Or/São Luiz, Rua Real Grandeza 108, sala 113, Botafogo, Rio de Janeiro, RJ, 22281-034, Brazil
| | - Henrique Serrão
- Interventional Radiology Department, Rede D' Or/São Luiz, Rua Real Grandeza 108, sala 113, Botafogo, Rio de Janeiro, RJ, 22281-034, Brazil
| | - Felipe Diniz
- Interventional Radiology Department, Rede D' Or/São Luiz, Rua Real Grandeza 108, sala 113, Botafogo, Rio de Janeiro, RJ, 22281-034, Brazil
| | | | | | - Nathalie Carvalho Leite
- Department of Internal Medicine/Hepatology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ladeira
- Emergency Department, Rede D' Or/São Luiz, Rio de Janeiro, Brazil
| | - Maria Chiara Chindamo
- Department of Internal Medicine/Hepatology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo Pereira
- Department of Internal Medicine / Hepatology, Federal Hospital of Bonsucesso, Rio de Janeiro, Brazil
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Sun XY, Wang GC, Wang J, Huang GJ, Zhang CQ. Transjugular intrahepatic portosystemic shunt is effective in patients with chronic portal vein thrombosis and variceal bleeding. Hepatobiliary Pancreat Dis Int 2021; 20:128-136. [PMID: 33455864 DOI: 10.1016/j.hbpd.2020.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies about treatment of patients with chronic portal vein thrombosis (CPVT) are still limited, especially in different types of CPVT. This study aimed to evaluate the effect of transjugular intrahepatic portosystemic shunt (TIPS) in all types of CPVT with variceal bleeding. METHODS Patients with CPVT who received TIPS treatment between January 2011 and June 2019 were divided into four types according to the extent of thrombosis. All patients had a history of variceal bleeding. The characteristics and clinical parameters were collected and recorded. Data on procedure success rate, variation in portal vein pressure, rebleeding, hepatic encephalopathy (HE), stent stenosis, and overall mortality were analyzed. RESULTS A total of 189 patients were included in this study (39 in type 1, 84 in type 2, 48 in type 3, 18 in type 4). The TIPS procedure success rate was 86.2%. The success rate was significantly different among the four types (89.7% vs. 88.1% vs. 83.3% vs. 77.8%, P = 0.001). In the TIPS success group, portal vein pressure was significantly reduced from 27.15 ± 6.59 to 19.74 ± 6.73 mmHg after the procedure (P < 0.001) and the rebleeding rate was significantly lower than that of the fail group (14.7% vs. 30.8%, P = 0.017). In addition, there were no significant differences in HE rate (30.7% vs. 26.9%, P = 0.912) or overall mortality (12.9% vs. 19.2%, P = 0.403) between the TIPS success group and the fail group. In the TIPS success group, we found that the occurrence of HE was significantly different (P = 0.020) among the four types, while there were no significant differences in rebleeding rate (P = 0.669), stent stenosis rate (P = 0.056), or overall mortality (P = 0.690). CONCLUSIONS TIPS was safe and effective in decreasing portal vein pressure and rebleeding rate in patients with CPVT.
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Affiliation(s)
- Xiao-Yan Sun
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Guang-Chuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jing Wang
- Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Guang-Jun Huang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Chun-Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China.
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Gioia S, Nardelli S, Pasquale C, Pentassuglio I, Nicoletti V, Aprile F, Merli M, Riggio O. Natural history of patients with non cirrhotic portal hypertension: Comparison with patients with compensated cirrhosis. Dig Liver Dis 2018; 50:839-844. [PMID: 29429910 DOI: 10.1016/j.dld.2018.01.132] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The knowledge of natural history of patients with portal hypertension (PH) not due to cirrhosis is less well known than that of cirrhotic patients. AIM To describe the clinical presentation and the outcomes of 89 patients with non-cirrhotic PH (25 with non-cirrhotic portal hypertension, INCPH, and 64 with chronic portal vein thrombosis, PVT) in comparison with 77 patients with Child A cirrhosis. METHODS The patients were submitted to a standardized clinical, laboratory, ultrasonographic and endoscopic follow-up. Variceal progression, incidence of variceal bleeding, portal vein thrombosis, ascites and survival were recorded. RESULTS At presentation, the prevalence of varices, variceal bleeding and ascites was similar in the 3 groups. During follow-up, the rate of progression to varices at risk of bleeding (p < 0.0001) and the incidence of first variceal bleeding (p = 0.02) were significantly higher in non-cirrhotic then in cirrhotic patients. A PVT developed in 32% of INCPH patients and in 18% of cirrhotics (p = 0.02). CONCLUSIONS In the patients with non-cirrhotic PH variceal progression is more rapid and bleeding more frequent than in cirrhotics. Patients with INCPH are particularly prompt to develop PVT. This observational study suggests that the management of patients with non-cirrhotic PH should take into consideration the natural history of portal hypertension in these patients and cannot be simply derived by the observation of cirrhotic patients.
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Affiliation(s)
- Stefania Gioia
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy.
| | - Silvia Nardelli
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy.
| | - Chiara Pasquale
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy.
| | - Ilaria Pentassuglio
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy
| | - Valeria Nicoletti
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy
| | - Francesca Aprile
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy.
| | - Manuela Merli
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy
| | - Oliviero Riggio
- Dept. of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, Rome, Italy
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Abstract
Background Portal vein thrombosis (PVT) is a rare but severe vascular disorder with an acute and a chronic course. Most patients have underlying liver cirrhosis; furthermore, thrombophilia is an important risk factor. However, idiopathic forms are also known. Methods This review discusses nonsurgical treatment options in PVT. Results and Conclusion Therapy of acute PVT is based on anticoagulation with heparin that is switched to oral anticoagulants, if applicable. Catheter-guided invasive therapy should be considered; however, patients with liver cirrhosis should be screened for portal hypertension before anticoagulation is mandatory. Therapy of chronic PVT is discussed controversially; therefore, a strict patient selection and an individual therapeutic decision are warranted depending on the etiology of PVT. Special forms of PVT including septic and malignant thrombosis as well as PVT in patients waiting for liver transplantation require particular therapy algorithms.
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Affiliation(s)
- Michael Schultheiß
- Department of Medicine II, University Hospital Freiburg, Freiburg i.Br., Germany
| | - Dominik Bettinger
- Department of Medicine II, University Hospital Freiburg, Freiburg i.Br., Germany
| | - Robert Thimme
- Department of Medicine II, University Hospital Freiburg, Freiburg i.Br., Germany
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