ABSTRACT
OBJECTIVE: The purpose of this study was to determine if duplex sonography of the hepatic vasculature can be used to detect venoocclusive disease in patients who have had bone marrow transplantation. SUBJECTS AND METHODS: Twenty-seven bone marrow transplant recipients were serially studied with hepatic duplex sonography before (n = 27) and biweekly after (n = 136) transplantation. Duplex waveforms were obtained from the hepatic artery and the portal and hepatic venous systems. Clinical records were reviewed to confirm the clinical diagnosis of venoocclusive disease (n = 5), including its time of onset and duration. Patients with venoocclusive disease were further split into two groups: those with clinically active disease and those with clinically inactive disease. The resistive index in the hepatic artery, the velocity in the portal vein, and the differences among bone marrow transplant values before and after transplantation were compared among the groups. RESULTS: On the basis of data obtained before transplantation, a resistive index greater than 0.76 and a change in resistive index greater than 0.10 after transplantation were considered abnormal. Similarly, velocity in the portal vein after transplantation was considered abnormal when the value was less than 4.3 cm/sec or more than 50.3 cm/sec. There was no statistically significant difference in the resistive index in the hepatic artery or velocity in the portal vein among patient groups. Hepatopetal portal venous flow was shown in 26 of 27 patients during the study. Portal venous flow was reversed in one patient with venoocclusive disease. Appropriately directed hepatic venous flow was demonstrated in all 27 patients. CONCLUSION: Our study shows that resistive index in the hepatic artery, velocity and flow direction in the portal vein, and flow direction in the hepatic vein as detected by duplex sonography are of no value in the diagnosis of venoocclusive disease after transplantation.
Subject(s)
Bone Marrow Transplantation/adverse effects , Hepatic Veno-Occlusive Disease/diagnostic imaging , Ultrasonography, Doppler, Duplex , Adult , Blood Flow Velocity , Female , Hepatic Artery/physiopathology , Hepatic Veins/physiopathology , Hepatic Veno-Occlusive Disease/etiology , Hepatic Veno-Occlusive Disease/physiopathology , Humans , Male , Middle Aged , Portal Vein/physiopathology , Prospective Studies , Vascular ResistanceABSTRACT
The case is presented of an infected, retained Hickman catheter cuff in a patient suffering from chronic graft-versus-host disease (GVHD) following allogeneic bone marrow transplantation. This infection seeded to a distant site causing systemic symptoms and requiring inpatient surgical and medical treatment. Although many physicians leave the dacron Hickman cuff in place when removing catheters, the presence of chronic skin changes associated with GVHD may predispose these patients to long-term infectious complications from this retained foreign body. We therefore advocate cuff removal at the time of catheter removal in all transplant patients.
