The role of communicant veins between hepatic veins in the treatment of Budd-Chiari syndrome with liver transplantation / 中华器官移植杂志

Objective Budd-Chiari syndrome is apt to be misdiagnosed,so we explore its diagnosis and treatment by liver transplantation.Methods We retrospectively analyzed the clinical data of two patients who underwent liver transplantation for Budd-Chiari syndrome.One patient was misdiagnosed before the transplantation and another was diagnosed correctly.Results Both patients were grouped to Child C category with decompensated liver cirrhosis.Patient 1 was diagnosed as recurrent hepatocellular carcinoma,but the etiology of liver disease was first unknown then suspected to be schistosomiasis.This patient underwent piggyback liver transplantation.Because there was significant swelling in the perineum and lower extremities after liver transplantation,we re-reviewed the preoperative imaging data and found communicant veins between hepatic veins,which proved that the patient was actually suffered from Budd-Chiari syndrome with hepatic vein and suprahepatic vena cava occlusion before the transplantation.After conservative treatment,the swelling of the lower body was alleviated,however,the long-term survival of the patient would be compromised.Learning from the first case,we found communicant veins between hepatic veins in imaging data of patient 2,resulting in correct diagnosis of Budd-Chiari syndrome with hepatic vein and retrohepatic vena cava diseases before the transplantation,so the patient underwent orthotopic liver transplantation,in which the liver and retrohepatic vena cava were resected,and recovered uneventfully.Liver function was normal during the follow up period of 7 months.Conclusion We should consider the possibility of Budd-Chiari syndrome in patients with unexplained end-stage liver diseases.Communicant veins between the hepatic veins shown in thin CT or MRI image are the characteristic sign for diagnosing Budd-Chiari syndrome.Simultaneously hepatic vein or cava vena disease determines the choice of various technique of liver transplantation.

Changes in portosystemic collaterals after endoscopic injection sclerotherapy: focused on magnetic resonance angiography / 대한내과학회지

BACKGROUND: This study was aimed at evaluating the changes of collateral circulation, using MR angiography (MRA), which is a non-invasive and a useful tool for viewing the porto-systemic circulation as a whole, following endoscopic injection sclerotherapy (EIS). METHODS: 30 patients who have portal hypertension with esophageal varices have taken MRA before the sclerotherapy and followed up 1 month after the eradication. RESULTS: The collaterals observed before EIS are as follows: left gastric vein 30 patients (100%), short gastric vein 2 patients (7%), gastro-renal shunt 2 patients (7%) and spleno-renal shunt 6 patients (20%). After the sclerotherapy, left gastric vein was obliterated in 12 patients (40%), decreased to 25% and 50% in 9 patients (30%) but, no change in 6 patients (20%), increased in 3 patients (10%). For short gastric vein, 25% and 50% size reduction was found in 2 patients. For gastro-renal shunt, no change in size was observed in 1 patient, increased to 25% in 1 patient. For spleno-renal shunt, it disappeared in 1 patients (17%) and decreased to 25% in 1 patient but, no change in 3 patients (50%), increased to 25% in 1 patients. CONCLUSION: Obliteration of left gastric vein was observed in many cases after the sclerotherapy and further evaluation is needed.

An Analysis of Extravariceal Collaterals of Gastric Varices Using Magnetic Resonance Angiography in Portal Hypertensive Patients / 대한소화기학회지

BACKGROUND/AIMS: This study was aimed to analyze the relationship between gastric varices and its collaterals using magnetic resonance angiography (MRA) and to assess the usefulness of MRA in studies of portosystemic circulation. METHODS: Eighty-one patients who had portal hypertension with gastric varices took MRA before the therapy for gastric varices. RESULTS: The types of collaterals observed by MRA were left gastric vein in 67 patients (83%), short gastric vein in 28 (35%), gastrorenal shunt in 25 (31%), and splenorenal shunt in 14 (17%). In most of patients with advanced gastric varices, the size of left gastric vein was larger than others. In most cases of large gastric varices, the short gastric vein ranged between 5 to 10 mm. Gastrorenal shunt was also correlated with the size of gastric varices. The types of more prominent esophageal varices showed a right type (left gastric vein predominance), but the types of more prominent gastric varices or only the gastric varices showed a left type (posterior or short gastric vein predominance) (p<0.05). CONCLUSIONS: Gadolinium enhanced 3D-MRA can contribute to the study of the hemodynamic relationships between gastric vein and the collateral circulations by presenting more clear images for patients with portal hypertension.