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Nuclear Medicine and Molecular Imaging

, Volume 44, Issue 3, pp 217–222 | Cite as

Huge Varicose Inferior Mesenteric Vein: an Unanticipated 99m Tc-labeled Red Blood Cell Scintigraphy Finding

  • Samaneh HoseinzadehEmail author
  • Babak Shafiei
  • Mohamadtaghi Salehian
  • Isa Neshandar Asli
  • Iraj Ghodoosi
Case Report

Abstract

Ectopic varices (EcV) are enlarged portosystemic venous collaterals, which usually develop secondary to portal hypertension (PHT). Mesocaval collateral vessels are unusual pathways to decompress the portal system. Here we report the case of a huge varicose inferior mesenteric vein (IMV) that drained into perirectal collateral veins, demonstrated by 99mTc-labeled red blood cell (RBC) scintigraphy performed for lower gastrointestinal (GI) bleeding in a 14-year-old girl. This case illustrates the crucial role of 99mTc-labeled RBC scintigraphy for the diagnosis of rare ectopic lower GI varices.

Keywords

Portal hypertension Ectopic varices Inferior mesenteric vein Gastrointestinal bleeding 99mTc-labeled red blood cell scintigraphy 

References

  1. 1.
    Francois F, Tadros C, Diehl D (2007) Pan-colonic varices and idiopathic portal hypertension. J Gastrointestin Liver Dis 16:325–328PubMedGoogle Scholar
  2. 2.
    Norton ID, Andrews JC, Kamath PS (1998) Management of ectopic varices. Hepatology 28:1154–1158CrossRefPubMedGoogle Scholar
  3. 3.
    Kinkhabwala M, Mousavi A, Iyer S, Adamsons R (1977) Bleeding ileal varicosity demonstrated by transhepatic portography. AJR Am J Roentgenol 129:514–516PubMedGoogle Scholar
  4. 4.
    Gallego C, Velasco M, Marcuello P, Tejedor D, De Campo L, Friera A (2002) Congenital and acquired anomalies of the portal venous system. Radiographics 22:141–159PubMedGoogle Scholar
  5. 5.
    Sarin SK, Kapoor D (2002) Non-cirrhotic portal fibrosis: Current concepts and management. J Gastroenterol Hepatol 17:526–534CrossRefPubMedGoogle Scholar
  6. 6.
    Vernava AM 3rd, Moore BA, Longo WE, Johnson FE (1997) Lower gastrointestinal bleeding. Dis Colon Rectum 40:846–858CrossRefPubMedGoogle Scholar
  7. 7.
    Helmy A, Al Kahtani K, Al Fadda M (2008) Updates in the pathogenesis, diagnosis and management of ectopic varices. Hepatol Int 2:322-34.Google Scholar
  8. 8.
    Howarth DM (2006) The role of nuclear medicine in the detection of acute gastrointestinal bleeding. Semin Nucl Med 36:133–146CrossRefPubMedGoogle Scholar
  9. 9.
    Mountz JM, Ripley SD, Gross MD, Richmond B (1986) The appearance of a large mesenteric varix on a technetium-99m red blood cell gastrointestinal bleeding study. Clin Nucl Med 11:229–232CrossRefPubMedGoogle Scholar
  10. 10.
    Karimeddini MK, Dambro TJ, Gabor MP, Spencer RP (1992) Omental varices detected on a radionuclide gastrointestinal bleeding study. Clin Nucl Med 17:672–673CrossRefPubMedGoogle Scholar
  11. 11.
    Yoshikai T, Yokomizo Y, Iwashita I, Okada Y, Koga H, Kudo S (1997) Inferior mesenteric varix demonstrated by 99mTc-red blood cell gastrointestinal bleeding study. Ann Nucl Med 11:163–166CrossRefPubMedGoogle Scholar
  12. 12.
    Kashiwagi T, Kimura K, Kozuka T, Sato N, Kamada T, Mitsutani N et al (1989) Portosystemic collaterals in portal hypertension: visualization by using blood-pool SPECT imaging. AJR Am J Roentgenol 153:281–285PubMedGoogle Scholar
  13. 13.
    Azuma M, Kashiwagi T, Nagasawa M, Ito Y, Naito M, Ishibashi K et al (2000) Evaluation of portosystemic collaterals by SPECT imaging after endoscopic variceal sclerotherapy: usefulness for predicting recurrence. J Nucl Med 41:600–604PubMedGoogle Scholar
  14. 14.
    Sarin SK, Kumar A (2006) Noncirrhotic portal hypertension. Clin Liver Dis 10:627–651CrossRefPubMedGoogle Scholar
  15. 15.
    Denninger MH, Chait Y, Casadevall N, Hillaire S, Guillin MC, Bezeaud A et al (2000) Cause of portal or hepatic venous thrombosis in adults: The role of multiple concurrent factors. Hepatology 31:587–91CrossRefPubMedGoogle Scholar
  16. 16.
    Tessler FN, Gehring BJ, Gomes AS, Perrella RR, Ragavendra N, Busuttil RW et al (1991) Diagnosis of portal vein thrombosis: value of color Doppler imaging. AJR Am J Roentgenol 157:293–296PubMedGoogle Scholar
  17. 17.
    Marn CS, Francis IR (1992) CT of portal vein occlusion. AJR Am J Roentgenol 159:717–726PubMedGoogle Scholar
  18. 18.
    Mortele KJ, Mergo PJ, Taylor HM, Wiesner W, Cantisani V, Ernst MD et al (2004) Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings. Eur J Radiol 52:67–72CrossRefPubMedGoogle Scholar
  19. 19.
    Nunez D, Russell E, Yrizarry J, Pereiras R, Viamonte M (1978) Portosystemic communications studied by transhepatic portography. Radiology 127:75–79PubMedGoogle Scholar
  20. 20.
    Akgul E, Inal M, Aikimbaev K, Celiktas M, Aksungur E (2003) Giant varicose inferior mesenteric vein. Eur J Radiol Extra 45:122–125CrossRefGoogle Scholar
  21. 21.
    Shapiro RS, Mendelson DS, Silvers AR, Gray CE, Halton KP, Miller CM (1990) Giant varices in portal hypertension: CT findings. Comput Med Imaging Graph 14:269–272CrossRefPubMedGoogle Scholar
  22. 22.
    Emre S, Dugan C, Frankenberg T, Hudgins LC, Gagliardi R, Artis AT et al (2009) Surgical portosystemic shunts and the Rex bypass in children: a single-centre experience. HPB (Oxford) 11:252–257Google Scholar
  23. 23.
    Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M et al (2001) Current outcome of portal vein thrombosis in adults: Risk and benefit of anticoagulant therapy. Gastroenterology 120:490–497CrossRefPubMedGoogle Scholar

Copyright information

© Korean Society of Nuclear Medicine 2010

Authors and Affiliations

  • Samaneh Hoseinzadeh
    • 1
    Email author
  • Babak Shafiei
    • 1
  • Mohamadtaghi Salehian
    • 2
  • Isa Neshandar Asli
    • 1
  • Iraj Ghodoosi
    • 2
  1. 1.Department of Nuclear Medicine, Taleghani HospitalShaheed Beheshti Medical UniversityTehranIran
  2. 2.Department of Vascular Surgery, Taleghani HospitalShaheed Beheshti Medical UniversityTehranIran

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