From 1944 to 1955, at the Ohio State University Hospital, 1 example was found among 358 splenectomies done for hematologic disorders. Computed tomography scan demonstrating a 2.5 cm density in the pancreatic tail . Liver injury can also be associated with bile duct, duodenal, pancreatic, bowel, and splenic injury. In 1956 . Splenic vein thrombosis may result in portal hypertension. The maximal diameter of all aneurysms ranged between 19 and 50 mm (meanSD, 28.49 . Am J Surg 2008;196, 149 -154. The splenic vein drains the blood from the spleen in 2-6 branches at the hilus and forms, together with the superior mesenteric vein, the portal vein at the splenoportal confluence. Specialty: Radiology Cross Sectional Grade: Consultant Location: London Job Description Are you an experienced Radiology Cross Sectional Consultant looking for an exciting new 11 days ago more. Figure 3. Note the hyperechoic capsule on the far border of the spleen. Splenic . The natural course of splenic vein aneurysms is uncertain and because of this condition, the timing and type of treatment remain controversial . Normal canine spleen - The typical homogenous smooth echotexture can be seen, with an anechoic area representing a branch of the splenic vein (arrow). Morphologically there are three types of venous aneurysms: fusiform, saccular and diverticular [2]. It can detect not only infringed lymph nodes but also pathological changes outside the junction. Its tributaries include the short gastric, left gastroepiploic, pancreatic, and inferior mesenteric veins (see Fig. The portal vein (PV) is the main vessel of the PVS, resulting from the confluence of the splenic and superior mesenteric veins, and drains directly into the liver, contributing to approximately 75% of its blood flow . In the several large series of splenoportograms reported in the literature since 1952, only single instances of thrombosis of the splenic vein have been demonstrated. The Doppler US findings seen in the complications described are often subtle and nonspecific and may evolve over time. The splenic vein is formed by splenic tributaries emerging at the splenic hilum in the splenorenal ligament at the tip of the tail of pancreas. 12-6B). In postcholecystectomy patients up to 10mm is normal. The intrahepatic IVC and the three main hepatic veins are also interrogated . For patients for more than 60 years, add one mm for every 10 years. Abdom Imaging Find similar topics on :: Scholar:: Radiology search engine 5. Variant anatomy Anomalies of hepatic artery origin and number are common 10,20-23 ( Table 12-2 ). London We offer you Autonomy, Flexibility . Sinistral Portal Hypertension; imaging findings and endovascular therapy. The definitive therapy for a wandering spleen is surgery. Figure 2. Link 31 Jan 1 note Portal and Splenic Vein Thrombosis nickthejam liked this radiologyreview posted this The splenic vein lies behind the upper border of the pancreas below the splenic artery (see Fig. Hepatic artery provides the remaining hepatic blood flow. Splenic vein thrombosis (plural: thromboses) is an uncommon condition in which the splenic vein becomes thrombosed, that most frequently occurs in the context of pancreatitis or pancreatic cancer. Intrahepatic bile ducts: <2mm is normal. If a conservative management approach is chosen it is important to maintain a close follow-up with magnetic resonance angiography, CT scan or ultrasonography (controlling changes in aneurismal size and/or in luminal flow) ( 4 , 6 ). Due to inaccessible splenic vein (one patient with history of splenectomy and 3 patients with unavailable splenic vein during the procedure), noninvasive direct puncture of superior ( n = 3) and inferior ( n = 1) mesenteric vein was conducted under ultrasound guidance to obtain access for PVR-TIPS. Configurations of the portal venous system aneurysms were fusiform in 37 patients and saccular in one. Splenic varices usually traverse the splenocolic ligament and are seen as dilated veins in the anteroinferior aspect of the spleen [ 20 ]. Normal diameter < 7 mm. The computed tomographic (CT) findings in 18 patients with angiographically proved, isolated splenic vein occlusion (SVO) were retrospectively analyzed. We report such a case of anteriorly placed splenic vein in a 40-year-old female prospective renal donor. Once completed, the imaging referral form should be faxed to: 020 3594 3199. Compared with other imaging examinations, PET/CT has a high sensitivity for NHL lesions. Splenomegaly appears to be a common accompaniment of splenic rupture in this disorder as seen in our case. Perisplenic collaterals can communicate with the gastric veins. Although risk factors like portal hypertension and liver cirrhosis have been highlighted, the etiology remains to be clarified. The distribution of venous collateral vessels and the frequency of their occurrence in these patients were then compared with CT findings in 17 patients with proved portal hypertension and normal CT findings in 20 patients. The most common causes of splenic vein occlusion are pancreatic diseases, such as pancreatic cancer, pancreatitis, or a pseudocyst. Bastarrika G, Bilbao JI, Martnez-Cuesta A, Elorz M, Vivas I . For imaging and Dexa scan referral forms please visit the dedicated referral section on our website. Interventional radiology . Splenic vein (vena splenica) The splenic vein is a large vessel located retroperitoneally in the upper part of the abdominal cavity. Most common sites are the main portal vein and confluence of splenic and superior mesenteric veins, forming extra-hepatic portal vein aneurysm (EPVA). While the literature on this topic is scarce, it seems that the consensus is that if splenic vein thrombosis is associated with portal hypertension, gastric or esophageal varices than splenectomy should be . Electronic address: urossi76@hotmail.com. The superior mesenteric vein (SMV) belongs to portal venous system, presents with a diameter of up to 1.2 cm and it is defined as aneurysmatic when it exceeds 1.4 cm in diameter together with loss of wall parallelism [1]. Additionally, splenic lesion biopsy confirmed a diagnosis of NHL. What is splenic artery aneurysm? Short gastric and . A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. Behind the neck of the pancreas, it confluences with the superior mesenteric vein to form the portal vein. Epidemiology The splenic artery supplies blood not only to the spleen, but also to the esophagus, stomach, duodenum, liver, and pancreas. National Locums. The main function of this blood vessel is to drain the venous blood from the spleen. (a) Proximal splenorenal shunt following splenectomy in which the proximal end of the cut splenic vein (SV) is anastomosed to the left renal vein (LRV). (b) Distal splenorenal shunt: SV is detached from the portal vein (PV) and reattached to the LRV. In mesenteric venous thrombosis, studies have shown that a CT scan of the abdomen has 90 percent accuracy. Much has been written about the myriad pathologic conditions that can occur in the spleen; however, there is little guidance on the approach to an incidental . It also treats the painfully enlarged spleen/hypersplenism and is preferred in adult patients. An intense inflammatory reaction, vasculitis and . Both penetrating and non-penetrating injury to the epigastric area result in injury to the left lobe of the liver. Agarwal A, Kumar R, Agarwal S, Sing S. Significane of Splenic Vein Thrombosis in Chroinc Pancreatitis. Splenic artery aneurysm is defined as a condition where there is a focal dilation in the diameter of the splenic artery that is 50% greater than the normal vessel diameter. Spectral Doppler waveform ultrasound of the splenic vein at the hilum shows a typical band-like flow profile with minimal respiratory fluctuations; flow is directed away from the transducer (away from the spleen). Splenic vein stenosis and thrombosis causes a localized form of portal hypertension known as left-sided hypertension and as a consequence, splenic vein stenosis and thrombosis may be complicated by the formation of varices, with the potential of massive upper . As such, the differential diagnosis and subsequent management are based primarily on imaging characteristics. It is therefore essential for preoperative evaluation of the anatomical details of the spleno-portal venous axis to be made by imaging. Edema, increase in cell size and lifting of the splenic capsule would suggest that stretching of the capsule may result in spontaneous hemorrhage. Evaluation of the viability of the splenic parenchyma, including any areas of infarction, is important as it guides therapy. Splenic vein thrombosis is uncommon and is usually described in relation to abdominal disease such as pancreatitis or trauma. To better assess the vessel, a MRI-MRA scan was performed: besides confirming the U/S findings, it revealed a dilatation of splenic and portal vein propably due to a shunt between splenic artery and splenic vein, and a splenic vein aneurysm (Figs 3, 4, 5). 2 Departamento de Imagen Diagnstica, Unidad de . Splenic vein thrombosis is a blood clot that is obstructing the splenic vein, which is located on the surface of the spleen. Find similar topics on :: Scholar:: Radiology search engine 6. It runs in the splenorenal ligament in close association with the splenic artery . The mechanism of splenic rupture in infectious mononucleosis is not completely understood. Normal peak systolic velocity of the splenic vein is 9-18 cm/sec. Affiliations 1 Departamento de Imagen Diagnstica, Unidad de Radiologa Interventiva, E.O. In patients without cirrhosis, the contrast medium rarely refluxes caudad in the portal vein but progresses cephalad through the liver. After a median of 234 days, the portal vein and its left or right branch were patent in 39% of anticoagulated patients (versus 13% initially), the splenic vein in 80% (versus 57% initially), and . The inferior mesenteric vein is the biggest vein which drains into the splenic vein (variance of 30 % into the superior mesenteric vein). When wandering spleen is suspected, radiologic imaging should locate the ectopic spleen and evaluate the anatomy and patency of the splenic vessels. It should be noted that the tortuous splenic veins frequently seen at the hilum of the enlarged spleen should not be called perisplenic varices. Whilst, for the most part asymptomatic, splenic vein thrombosis increases risk of gastric varices and associated upper GI hemorrhage. View similar jobs: Consultant Radiology Jobs in London; Jobs in London; Consultant In Gynaecology Radiology - Central London Save. Discussion Case Type. Although the splenic vein usually marks the dorsal margin of the body and tail of the pancreas, the tip of the gland may rarely curve dorsal to the splenic vein to simulate adrenal abnormalities ( Fig. Mohy-ud-din, Nabeeha MD; Bedi, Gurneet MD; Garg, Mrinal MD; Dhawan, Manish MD. In addition to the spleen, it drains parts of the stomach, pancreas and the hindgut. What causes splenic varices? Clinical data were reviewed for sequela of SVO and clinical impact of the diagnosis.
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