Portal Venous Thrombosis or Sclerosis in Liver Transplantation Candidates: Preoperative CT Findings and Correlation with Surgical Procedure1
Giuseppe Brancatelli, MD,
Michael P. Federle, MD,
Karen Pealer and
David A. Geller, MD
1 From the Departments of Radiology (G.B., M.P.F., K.P.) and Surgery (D.A.G.), University of Pittsburgh Medical Center, Presbyterian Hospital, Rm 4660, 200 Lothrop St, Pittsburgh, PA 15213-2582. Received October 6, 2000; revision requested November 16; revision received January 29, 2001; accepted February 26. G.B. supported by the Nicholas Green Fulbright Grant. Address correspondence to M.P.F. (e-mail: federle@pitt.edu).
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Figure 1. Schematic of PV abnormalities found at surgery and at CT. Inf. = inferior, Sup. = superior, V. = vein.
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Figure 2. Schematic of interposition venous graft. When extensive thrombosis, sclerosis, or calcification of the PV is encountered, an iliac venous graft is often used to bypass the thrombosed vessel. Sup. = superior, V. = vein.
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Figure 3a. Thrombosed and sclerosed PV with large collateral vein used for anastomosis. (a) Transverse enhanced CT scan. No PV, only a cordlike structure, could be identified at the porta hepatis at CT or surgery. A dilated coronary vein (arrow) was anastomosed to the donor PV at OLT. (b) More caudal transverse CT scan shows thrombus (arrow) within the superior mesenteric vein that prevented the use of an interposition venous graft.
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Figure 3b. Thrombosed and sclerosed PV with large collateral vein used for anastomosis. (a) Transverse enhanced CT scan. No PV, only a cordlike structure, could be identified at the porta hepatis at CT or surgery. A dilated coronary vein (arrow) was anastomosed to the donor PV at OLT. (b) More caudal transverse CT scan shows thrombus (arrow) within the superior mesenteric vein that prevented the use of an interposition venous graft.
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Figure 4a. Thrombosed and sclerosed PV with spontaneous splenorenal shunt. (a) Transverse enhanced CT scan obtained through the porta hepatis. No patent lumen of the PV is identified. (b) Transverse enhanced CT scan shows thrombus (solid arrow) at the portal confluence. A spontaneous splenorenal shunt is evident, with enlarged perisplenic varices (open arrow), an enlarged left renal vein (not shown), and a dilated inferior vena cava (IVC). An interposition venous graft was required.
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Figure 4b. Thrombosed and sclerosed PV with spontaneous splenorenal shunt. (a) Transverse enhanced CT scan obtained through the porta hepatis. No patent lumen of the PV is identified. (b) Transverse enhanced CT scan shows thrombus (solid arrow) at the portal confluence. A spontaneous splenorenal shunt is evident, with enlarged perisplenic varices (open arrow), an enlarged left renal vein (not shown), and a dilated inferior vena cava (IVC). An interposition venous graft was required.
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Figure 5. Calcification within the PV wall. Transverse CT scan demonstrates linear calcification (arrow) within the wall of the PV. During OLT, the patient lost 20 units of blood and had a fatal cardiac arrest.
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Figure 6. Nonocclusive thrombus within the main PV. Transverse enhanced CT scan shows the PV just dorsal to the hepatic artery (HA). Thrombus fills more than half of the PV lumen, but contrast-enhanced blood (arrow) is present within the patent lumen. Thrombectomy and direct PV-to-PV anastomosis were performed.
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Figure 7. Extension of clot into the superior mesenteric vein (SMV). Transverse enhanced CT scan shows that clot filled the PV (not shown) and extended caudally into the superior mesenteric vein (straight arrow). Note the edematous mesentery (arrowheads) and mesenteric varices (curved arrow). Thrombectomy and direct PV-to-PV anastomosis were performed.
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Figure 8. Calcification within nonocclusive thrombus. Transverse enhanced CT scan shows a punctate calcification (arrow) within the thrombus, which occupies more than 50% of the lumen of the PV. Thrombectomy and direct PV-to-PV anastomosis were performed.
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Copyright © 2001 by the Radiological Society of North America.
