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Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review

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Abstract

Purpose

Portosystemic collateral vessels (PSCV) are a consequence of the portal hypertension that occurs in chronic liver diseases. Their prognosis is strongly marked by the risk of digestive hemorrhage and hepatic encephalopathy.

Materials and methods

CT was performed with a 16-MDCT scanner. Maximum intensity projection and volume rendering were systematically performed on a workstation to analyze PSCV.

Results

We describe the PSCV according to their drainage into either the superior or the inferior vena cava. In the superior vena cave group, we found gastric veins, gastric varices, esophageal, and para-esophageal varices. In the inferior vena cava group, the possible PSCV are numerous, with different sub groups: gastro and spleno renal shunts, paraumbilical and abdominal wall veins, retroperitoneal shunts, mesenteric varices, gallbladder varices, and omental collateral vessels. Regarding clinical consequences esophageal and gastric varices are most frequently involved in digestive bleeding; splenorenal shunts often lead to hepatic encephalopathy; the paraumbilical vein is an acceptable derivation pathway for natural decompression of the portal system.

Conclusion

Knowledge of precise cartography of PSCV is essential to therapeutic decisions. MDCT is the best way to understand and describe the different types of PSCV.

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Authors and Affiliations

  1. Department of Radiology, Angers University Hospital, Angers, France

    Elie Moubarak, Antoine Bouvier, Jérôme Lebigot, Catherine Ridereau-Zins, Francine Thouveny, Serge Willoteaux & Christophe Aubé

  2. Department of Hepatogastroenterology, Angers University Hospital, Angers, France

    Jérôme Boursier

  3. Laboratory HIFIH, Angers University, UPRES 3859, IFR 132, Angers, France

    Jérôme Boursier & Christophe Aubé

Authors
  1. Elie Moubarak
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  2. Antoine Bouvier
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  3. Jérôme Boursier
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  4. Jérôme Lebigot
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Correspondence to Christophe Aubé.

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Moubarak, E., Bouvier, A., Boursier, J. et al. Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review. Abdom Radiol 37, 746–766 (2012). https://doi.org/10.1007/s00261-011-9811-0

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  • DOI: https://doi.org/10.1007/s00261-011-9811-0

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