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Venous thrombosis and segmental hypoperfusion in amebic liver abscess: MDCT demonstration and its implications

  • Hepatobiliary
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Abstract

Purpose

To report venous thrombosis and associated perfusion defect in amebic liver abscess (ALA) using MDCT.

Method

MDCT images of 62 patients with ALA were reviewed for venous thrombosis and associated perfusion abnormalities.

Result

The study found 43 (69%) patients with venous thrombosis: portal vein thrombosis (PVT) occurred in 39, hepatic vein thrombosis (HVT) in 37 and inferior vena cava (IVC) thrombosis in 4. Combined PVT and HVT occurred in 33 (77%) patients. The portal vein thrombi remained localized in subsegmental branches in 25 patients and extended to segmental branches in 14. The hepatic vein thrombi were confined to peripheral branches in 18 patients; they progressed to the main trunk in 19 and to the IVC in 4. A wedge-shaped hypoattenuating zone suggesting ischemia was identified in 33 (77%) patients in portal phase: 31 had combined PVT and HVT, 2 had HVT alone, but none had PVT alone. It occurred significantly more often with combined PVT and HVT than HVT alone (p = 0.05). Arterial phase enhancement occurred in 2 of 13 patients with multiphasic CT. All patients were symptomatic despite medical therapy and therefore required percutaneous drainage. About half of the patients were identified with ruptured abscesses. Segmental atrophy was observed in seven of nine patients who underwent follow-up CT.

Conclusion

Combined PVT and HVT commonly occur with ALA and often manifests as segmental hypoperfusion in portal venous phase, indicating ischemia. The detection of such events by CT may be indicative of severe disease that requires aggressive management involving percutaneous drainage.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Radio-Diagnosis, All India Institute of Medical Sciences, Patna, Bihar, India

    Rajeev Nayan Priyadarshi & Prem Kumar

  2. Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India

    Ramesh Kumar

  3. Department of G.I. Surgery, All India Institute of Medical Sciences, Patna, Bihar, India

    Utpal Anand

  4. Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India

    Shyama

Authors
  1. Rajeev Nayan Priyadarshi
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  2. Prem Kumar
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  3. Ramesh Kumar
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  4. Utpal Anand
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  5. Shyama
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Correspondence to Rajeev Nayan Priyadarshi.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Our Institutional Review Board approved this study and informed consent was obtained from all patients.

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Priyadarshi, R.N., Kumar, P., Kumar, R. et al. Venous thrombosis and segmental hypoperfusion in amebic liver abscess: MDCT demonstration and its implications. Abdom Radiol 45, 652–660 (2020). https://doi.org/10.1007/s00261-020-02409-6

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  • DOI: https://doi.org/10.1007/s00261-020-02409-6

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