ABSTRACT
Objective To summarize the diagnosis and treatment experience of portal vein aneurysm after liver transplantation. Methods Clinical data of two recipients with portal vein aneurysm after liver transplantation were retrospectively analyzed. Clinical features, diagnosis, treatment and prognosis were summarized based on literature review. Results Both two cases were diagnosed with intrahepatic portal vein aneurysm complicated with portal vein thrombosis and portal hypertension after liver transplantation. Case 1 was given with targeted conservative treatment and he refused to undergo liver retransplantation. Physical condition was worsened after discharge, and the patient eventually died from liver graft failure, kidney failure, lung infection, and septic shock. Case 2 received high-dose glucocorticoid pulse therapy, whereas liver function was not improved, and the patient was recovered successfully after secondary liver transplantation. Conclusions Long-term complication of portal vein aneurysm (especially intrahepatic type) after liver transplantation probably indicates poor prognosis. Correct understanding, intimate follow-up and active treatment should be conducted. Liver retransplantation may be a potential treatment regimen.
ABSTRACT
Objective To investigate the clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm.Methods The method of retrospective descriptive study was conducted.The clinical data of 1 patient with extra-hepatic portal vein aneurysm who was admitted to the Guangzhou General Hospital of Guangzhou Military Command of PLA in May 2014 were collected.The patient suffered from dull pain in his epigastrium,with no obvious causative factors.The patient recieved abdominal B-ultrasound,CT scans abdominal and superior mesenteric artery,angiographies after admission in May 2014,and was diagnosed as with extra-hepatic portal vein aneurysm.The preventative surgical resection was selected according to the patient's individual health status.Extra-hepatic portal vein aneurysm resection was conducted under the guidance of intraoperative ultrasonography after abdominal exploration.A double-cavity drainage tube was placed in the venturis hole when portal vein aneurysm was dissected and removed.Then the abdomen was closed.The patient received regular perioperative management.The operation time,volume of intraoperative blood loss,time for diet recovery,time of drainage tube removal,postoperative complications,results of laboratory tests,results of imaging findings,healing of incision,time of postoperative discharge from hospital,results of pathologic examination and follow-up were observed.Follow-up using outpatient examination or telephone interview was performed to detect the inspect status of portal vein and inspect recurrence of portal vein aneurysm by abdominal B-ultrasound and CT examinations till December 2014.Results The patient underwent successful extra-hepatic portal vein aneurysm resection.The operation time was 85 minutes and the volume of intraoperative blood loss was around 150 mL.The patient gradually returned to normal diet and self-care ability at postoperative day 3,and the abdominal drainage tube was removed at postoperative day 3.No postoperative complications including hemorrhage,portal vein thrombosis and dysfunction of liver were detected after operation.There were normal levels of blood routine and blood biochemical test.Postoperative B-ultrasound examination showed smooth blood flow in portal vein and the abdominal blood vessel CT angiography presented clear image of the portal vein,with smooth blood flow and normal lumen.The surgical incision recovered very well and the patient was discharged from hospital at postoperative day 9.Results of postopeartive pathologic examination showed that there were cystic-like tissues with simple squamous epithelium cells on the interior,the wall of which consisted of smooth muscle was in accordance of the structure of vein.The patient didn't receive any other special treatment or take medicines postoperatively.The patient had good physical health and can take care of himself during six-month follow-up,without narrow portal vein,recurrence of portal vein aneurysm and other complications.Conclusion Preventative surgical resection is safe and feasible for extra-hepatic portal vein aneurysm,with a good efficacy.
ABSTRACT
Objective To evaluate CT and MRI findings of portal vein aneurysm(PVA)in order to improve its diagnostic accuracy.Methods CT and MRI findings of 9 patients with PVA proved by pathology and direct angiography were reviewed retrospectively.CT scanning was performed in 7 patients,including plain scan (n=2),both plain and enhanced scan (n=5),CT angiography (CTA)(n=3).Plain and enhanced MRI scan were performed in 3 patients.Results (1 )PVA showed a high predilection for old adults.(2 )Of the 9 tumors,4 located in portal vein trunk,2 located in junction of superior mesenteric vein and portal vein trunk,1 located in intrahepat-ic-extrahepatic portal vein,2 located in intra-hepatic portal vein.(3)8 tumors were characterized as well-defined and quasi-circular mass.1 patient occurred portal hypertension,thrombus as the portal vein trunk was oppressed by the tumor.(4)Plain CT showed the mass was slightly higher than pancreas parenchyma density,and uniform with the density of the liver parenchyma.Enhancement scanning showed 4 tumors represented mild or moderate enhancement in portal venous phase except for 1 patient accompany with portal vein thrombus.CTA showed clearly the relationship mass with portal vein,and classified the type of PVA .The 3 lesions represented hypo-intensity on T1 WI and even hyper-intensity on T2 WI.Enhancement scanning showed the tumor was significantly enhancement in portal venous phase on T1 WI.Conclusion CT and MRI have their own advantages in the diagnosis of portal vein aneurysm.Com-bination of CT and MRI could improve the diagnostic accuracy of portal vein aneurysm.
ABSTRACT
A congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm is a rare type of arteriovenous malformation. Only 14 pediatric cases have been reported to the best of the authors' knowledge. An intrahepatic shunt between the portal and systemic veins is also relatively rare. We report a case of a congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm and a portohepatic venous shunt in a neonate who presented with tachypnea and melena.
Subject(s)
Humans , Infant, Newborn , Aneurysm , Angiography , Arteriovenous Fistula , Arteriovenous Malformations , Melena , Portal Vein , Tachypnea , VeinsABSTRACT
Aneurysm of the portal venous system is extremely rare and its etiology is controversial. In the following study, a case congenital aneurysm of the portal vein is reported. A 47-year-old male had a one-year history of generalized weakness. During routine evaluation, an ultrasound examination showed a masslike dilatation of the portal vein near the porta hepatis and its distal portion was communicating with the normal-sized superior mesenteric vein. The diagnosis was confirmed by dynamic computed tomography and portal venography as portal vein aneurysm and an unusually tortuous portal vein. The patient had no history or clinical evidence of underlying liver disease, pancreatitis, or other disease states that would predispose development of an aneurysm. It was speculated that this portal vein aneurysm may have been congenital and that the associated tortuous portal vein may have been secondary to hemodynamic changes in the portal vein system.