Splenic . Affiliations 1 Departamento de Imagen Diagnstica, Unidad de Radiologa Interventiva, E.O. Abdom Imaging Find similar topics on :: Scholar:: Radiology search engine 5. What is splenic artery aneurysm? 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]. In addition to the spleen, it drains parts of the stomach, pancreas and the hindgut. Both penetrating and non-penetrating injury to the epigastric area result in injury to the left lobe of the liver. Normal diameter < 7 mm. Figure 2. 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 ). (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). 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. In patients without cirrhosis, the contrast medium rarely refluxes caudad in the portal vein but progresses cephalad through the liver. The increased pressure in the splenic vein causes the spleen to enlarge, and other veins to dilate and twist in the esophagus and stomach; internal bleeding may occur. 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). Mohy-ud-din, Nabeeha MD; Bedi, Gurneet MD; Garg, Mrinal MD; Dhawan, Manish MD. Most common sites are the main portal vein and confluence of splenic and superior mesenteric veins, forming extra-hepatic portal vein aneurysm (EPVA). In 1956 . The natural course of splenic vein aneurysms is uncertain and because of this condition, the timing and type of treatment remain controversial . New magnetic resonance (MR) imaging techniques have increased the role of MR imaging in detection and characterization of splenic diseases. In postcholecystectomy patients up to 10mm is normal. Hepatic artery provides the remaining hepatic blood flow. Splenic vein thrombosis is uncommon and is usually described in relation to abdominal disease such as pancreatitis or trauma. Figure 3. Additionally, splenic lesion biopsy confirmed a diagnosis of NHL. Find similar topics on :: Scholar:: Radiology search engine 6. Perisplenic collaterals can communicate with the gastric veins. View chapter Purchase book Behind the neck of the pancreas, it confluences with the superior mesenteric vein to form the portal vein. Doppler ultrasound is the best initial diagnostic test in cases with a suspicion of splenic vein thrombosis when considering all these facts. To the best of our knowledge, this represents the second reported case of an anteriorly placed splenic vein. Computed tomography scan demonstrating a 2.5 cm density in the pancreatic tail . Results Variant anatomy Anomalies of hepatic artery origin and number are common 10,20-23 ( Table 12-2 ). The Doppler US findings seen in the complications described are often subtle and nonspecific and may evolve over time. 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. It can detect not only infringed lymph nodes but also pathological changes outside the junction. (b) Distal splenorenal shunt: SV is detached from the portal vein (PV) and reattached to the LRV. 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. Discussion Thus, the radiologist must . The branches of the splenic vein, which converge at the splenic hilus, are more readily identified. We report a case of SVT in a patient with a previous history of pancreatitis . Case Type. Configurations of the portal venous system aneurysms were fusiform in 37 patients and saccular in one. Bastarrika G, Bilbao JI, Martnez-Cuesta A, Elorz M, Vivas I . Splenic vein thrombosis is rarely diagnosed with certainty prior to surgery or autopsy. The most common causes of splenic vein occlusion are pancreatic diseases, such as pancreatic cancer, pancreatitis, or a pseudocyst. 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. The computed tomographic (CT) findings in 18 patients with angiographically proved, isolated splenic vein occlusion (SVO) were retrospectively analyzed. Free ; 2926_A Figure 1. Am J Surg 2008;196, 149 -154. Agarwal A, Kumar R, Agarwal S, Sing S. Significane of Splenic Vein Thrombosis in Chroinc Pancreatitis. 12-6B). The main function of this blood vessel is to drain the venous blood from the spleen. 12-3 ). In paediatric patients, 4mm is upper limit. The splenic artery supplies blood not only to the spleen, but also to the esophagus, stomach, duodenum, liver, and pancreas. Clinical Cases Authors. The maximal diameter of all aneurysms ranged between 19 and 50 mm (meanSD, 28.49 . It also treats the painfully enlarged spleen/hypersplenism and is preferred in adult patients. Once in the liver, PV ramifies and reaches the sinusoids, with downstream blood being directed to the central vein at . Evaluation of the viability of the splenic parenchyma, including any areas of infarction, is important as it guides therapy. Morphologically there are three types of venous aneurysms: fusiform, saccular and diverticular [2]. The majority of primary splenic NHL originates from B cells, characterizing splenomegaly. The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. However, various other cancers, such as colon, gastric, or renal cancers, have also been known to cause splenic vein occlusion. gamna-gandy bodies in spleen gamna-gandy bodies in spleen gamna-gandy bodies in spleen We report such a case of anteriorly placed splenic vein in a 40-year-old female prospective renal donor. Electronic address: urossi76@hotmail.com. Compared with other imaging examinations, PET/CT has a high sensitivity for NHL lesions. The diagnosis of LSPH caused by idiopathic splenic vein stenosis was made by transhepatic portal and splenic venography with pressure measurements, which revealed a focal stenosis of the splenic vein near the splenic hilum, with a post-stenotic dilatation and short gastric veins draining into the LGV through the gastric wall varices. Splenomegaly appears to be a common accompaniment of splenic rupture in this disorder as seen in our case. Sinistral Portal Hypertension; imaging findings and endovascular therapy. RSNA, 2005 Article History Published in print: July 2005 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 . View similar jobs: Consultant Radiology Jobs in London; Jobs in London; Consultant In Gynaecology Radiology - Central London Save. Splenic vein thrombosis is a blood clot that is obstructing the splenic vein, which is located on the surface of the spleen. 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. Intrahepatic bile ducts: <2mm is normal. Although risk factors like portal hypertension and liver cirrhosis have been highlighted, the etiology remains to be clarified. In mesenteric venous thrombosis, studies have shown that a CT scan of the abdomen has 90 percent accuracy. Epidemiology Portal imaging includes the main portal vein, the right and left intrahepatic portal vein branches, and the splenic vein. It runs in the splenorenal ligament in close association with the splenic artery . Once completed, the imaging referral form should be faxed to: 020 3594 3199. Hospital Galliera, Gnova, Italia; Unidad de Radiologa Interventiva, Departamento de Tecnologa Avanzada de Diagnstico y Terapia, ASST Santi Paolo y Carlo-Hospital San Carlo Borromeo, Miln, Italia. 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 . A normal splenic vein doppler will make the diagnosis of splenic vein thrombosis highly improbable. It is therefore essential for preoperative evaluation of the anatomical details of the spleno-portal venous axis to be made by imaging. An intense inflammatory reaction, vasculitis and . When wandering spleen is suspected, radiologic imaging should locate the ectopic spleen and evaluate the anatomy and patency of the splenic vessels. This is the . MR imaging is an excellent tool for diagnosis and evaluation of focal lesions and pathologic conditions of the spleen. Normal peak systolic velocity of the splenic vein is 9-18 cm/sec. Splenic vein thrombosis may result in portal hypertension. Normal canine spleen - The typical homogenous smooth echotexture can be seen, with an anechoic area representing a branch of the splenic vein (arrow). A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. Methods: A computer search of radiology reports for a 1-year period found 52 patients with SVO diagnosed by absence of visualization of the splenic vein accompanied by the formation of the expected perigastric collateral veins. The mechanism of splenic rupture in infectious mononucleosis is not completely understood. 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 . For imaging and Dexa scan referral forms please visit the dedicated referral section on our website. Splenic lesions are commonly discovered incidentally at imaging, without clinical signs or symptoms that may aid in diagnosis. What causes splenic varices? There is a need to consider several factors in choosing whether to anticoagulate the patient. The splenic vein lies behind the upper border of the pancreas below the splenic artery (see Fig. 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. 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). For patients for more than 60 years, add one mm for every 10 years. It should be noted that the tortuous splenic veins frequently seen at the hilum of the enlarged spleen should not be called perisplenic varices. Once completed, the imaging referral form should be faxed to: 020 3594 3199. Allegheny Health Network, Pittsburgh, PA. American Journal of Gastroenterology: October 2018 - Volume 113 - Issue - p S1611-S1612. 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. Note the hyperechoic capsule on the far border of the spleen. 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. The inferior mesenteric vein is the biggest vein which drains into the splenic vein (variance of 30 % into the superior mesenteric vein). 96-7 ). Author Information . It is associated with complications of significant gastrointestinal bleeding and high morbidity if the thrombus propagates. Splenic vein thrombosis (SVT) is a well-recognized complication of acute and chronic pancreatitis. Whilst, for the most part asymptomatic, splenic vein thrombosis increases risk of gastric varices and associated upper GI hemorrhage. Link 31 Jan 1 note Portal and Splenic Vein Thrombosis nickthejam liked this radiologyreview posted this As such, the differential diagnosis and subsequent management are based primarily on imaging characteristics. Splenic varices usually traverse the splenocolic ligament and are seen as dilated veins in the anteroinferior aspect of the spleen [ 20 ]. Liver injury can also be associated with bile duct, duodenal, pancreatic, bowel, and splenic injury. 2 Departamento de Imagen Diagnstica, Unidad de . National Locums. London We offer you Autonomy, Flexibility . From 1944 to 1955, at the Ohio State University Hospital, 1 example was found among 358 splenectomies done for hematologic disorders. The definitive therapy for a wandering spleen is surgery. Normal diameter of the common hepatic duct is less than 5mm. The most frequent sites of the aneurysms were the main portal vein in 20 (53%) and the splenic vein in eight (21%) of the 38 portal venous system aneurysms. Deceleration injuries may result in lobe rupture, hepatic vein avulsion and inferior vena cava injuries. Edema, increase in cell size and lifting of the splenic capsule would suggest that stretching of the capsule may result in spontaneous hemorrhage. Relations Overview. Short gastric and . Interventional radiology . Splenic vein (vena splenica) The splenic vein is a large vessel located retroperitoneally in the upper part of the abdominal cavity. Splenic Vein Aneurysm: A Rare and Incidental Finding 2926. The injection of a radiopaque substance, under pressure, through an umbilical vein catheter results in dispersion of the agent throughout the intrahepatic portal venous system. 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 . 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