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De la Garza-Ramos C, Muneer MS, Lewis JT, Harnois DM, Taner CB, Frey GT, Rosser B, Toskich BB. Transportal Technetium-99m Labeled Macroaggregated Albumin Scintigraphy to Quantify Occult Intrahepatic Microvascular Portosystemic Shunting. Radiol Case Rep 2021; 16:975-978. [PMID: 33664925 PMCID: PMC7900641 DOI: 10.1016/j.radcr.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Nodular regenerative hyperplasia (NRH) of the liver may lead to noncirrhotic portal hypertension with subsequent development of portosystemic shunts. While extrahepatic and macrovascular shunts are readily visualized with imaging or endoscopy, there is no standard technique to detect intrahepatic microvascular portosystemic shunting and quantitatively assess shunt burden. We present a case of a 53-year-old female with suspected NRH and hepatopulmonary syndrome with inconclusive liver biopsies and absent portosystemic shunts per abdominal imaging. A percutaneous transportal infusion of Technetium-99m labeled macroaggregated albumin (99mTc-MAA) successfully identified intrahepatic microvascular portosystemic shunting and quantified a lung shunt fraction of more than 30%. NRH was subsequently confirmed with a surgical wedge biopsy and the patient was successfuly treated with a liver transplant. Transportal 99mTc-MAA could be used to both identify and quantify otherwise occult microvascular portosystemic shunts in patients with clinical sequelae of portal hypertension.
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Affiliation(s)
- Cynthia De la Garza-Ramos
- Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Mohamed S. Muneer
- Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Jason T. Lewis
- Department of Pathology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Denise M. Harnois
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - C. Burcin Taner
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Gregory T. Frey
- Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Barry Rosser
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Beau B. Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
- Corresponding author.
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