ABSTRACT
PURPOSE: We evaluated anatomical variations of spontaneous splenorenal shunt (SSRS) and the prevalence of portosystemic shunts in patients with chronic liver disease by CT. MATERIALS AND METHODS: A total of 451 patients with chronic liver disease underwent contrast-enhanced computed tomography between October 2010 and April 2011. The prevalence of portosystemic shunts including SSRS and gastrorenal shunt, and the frequency of hepatic encephalopathy were examined. The course of the shunt and the point of confluence with the renal vein of the SSRS were analyzed. RESULTS: SSRSs or gastrorenal shunts were found in 11.1 and 5.0% of the patients, respectively. Anatomical variations were classified into three types according to the point of confluence as follows: type 1 = the SSRS joined the inferior phrenic vein (n = 33), type 2 = the SSRS joined the gonadal vein (n = 7), and type 3 = the SSRS joined the left renal vein (n = 14). The course of the SSRS from the splenic hilum was classified as medial (n = 46), posterior (n = 2), or anterolateral (n = 2). CONCLUSIONS: SSRSs were classified into three types depending on the confluence point with the renal vein, and into three types of course. These findings are useful for preoperative information.
Subject(s)
Liver Diseases/diagnostic imaging , Splenorenal Shunt, Surgical , Adult , Aged , Aged, 80 and over , Chronic Disease , Contrast Media , Female , Hepatic Encephalopathy/diagnostic imaging , Humans , Image Enhancement/methods , Male , Middle Aged , Tomography, X-Ray Computed/methodsABSTRACT
Case: We report a case of hemorrhagic shock due to a ruptured gastric artery aneurysm successfully treated with transarterial embolization. A 72-year-old woman with cholangitis presented with hemoperitoneum following a ruptured aneurysm of the gastric artery. Outcome: Emergent computed tomography and angiography were carried out and the patient was found to have spontaneous bleeding from both branches of the left and right gastric arteries. Transcatheter embolization was carried out at the distal branch of both gastric arteries with a coil. The patient recovered well with no recurrent bleeding. Conclusions: Although rare, visceral artery rupture should be considered in the differential diagnosis of unexplained hemorrhagic shock with abrupt onset of hemoperitoneum. Computed tomography and angiography are useful tools for obtaining prompt and accurate localization of the bleeding points.
ABSTRACT
The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.
Subject(s)
Aneurysm/therapy , Embolization, Therapeutic/instrumentation , Splenic Artery , Splenic Infarction/etiology , Adult , Aged , Aged, 80 and over , Aneurysm/diagnostic imaging , Aneurysm, False/diagnostic imaging , Aneurysm, False/therapy , Angiography/methods , Catheterization/methods , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/methods , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Assessment , Splenic Infarction/therapy , Tomography, X-Ray Computed , Treatment Outcome , Vascular Patency/physiologyABSTRACT
We report a case of extrapontine myelinolysis (EPM) precipitated by correction of a hyper-osmolar state. A 7-year-old boy presented with disturbed consciousness. Serum BUN and Na level were 48 mg/dl and 196 mmol/L, respectively. T2-weighted images and FLAIR images of MRI visualized symmetrical bilateral high signal intensity areas in the external capsule and in the thalamus. In addition, the splenium of the corpus callosum showed high signal intensity. All these lesions showed high signal intensity on diffusion-weighted images. Extrapontine myelinolysis is precipitated not only by the rapid correction of a hypo-osmolar state but also by that of a hyper-osmolar state.
