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CT Depiction of Portal Vein Thrombi after Creation of Ileal Pouch–Anal Anastomosis¹

¹ From the Departments of Radiology (M.E.B., D.E., B.H., E.R.) and Colorectal Surgery (F.R., M.O., V.F.), Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. From the 2001 RSNA scientific assembly. Received February 4, 2002; revision requested April 9; revision received June 7; accepted July 25. Address correspondence to M.E.B. (e-mail: bakerm@ccf.org).

View larger version (139K): [in a new window]   Figure 1a. Transverse contrast medium-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows occlusive thrombi in segments VII (solid arrow) and VIII (open arrows). (b) CT scan obtained just caudal to a shows an occlusive left portal vein thrombus (straight solid arrow), as well as the occlusive thrombi in segments VII (curved arrow) and VIII (open arrow). (c) CT scan through the porta hepatis shows a nonocclusive thrombus bridging the right and left portal veins (straight arrow) and the occlusive thrombus in segment VII (curved arrow). (d) CT scan through the lower portion of the liver shows occlusive thrombi in segment V (arrowheads).

View larger version (143K): [in a new window]   Figure 1b. Transverse contrast medium-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows occlusive thrombi in segments VII (solid arrow) and VIII (open arrows). (b) CT scan obtained just caudal to a shows an occlusive left portal vein thrombus (straight solid arrow), as well as the occlusive thrombi in segments VII (curved arrow) and VIII (open arrow). (c) CT scan through the porta hepatis shows a nonocclusive thrombus bridging the right and left portal veins (straight arrow) and the occlusive thrombus in segment VII (curved arrow). (d) CT scan through the lower portion of the liver shows occlusive thrombi in segment V (arrowheads).

View larger version (149K): [in a new window]   Figure 1c. Transverse contrast medium-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows occlusive thrombi in segments VII (solid arrow) and VIII (open arrows). (b) CT scan obtained just caudal to a shows an occlusive left portal vein thrombus (straight solid arrow), as well as the occlusive thrombi in segments VII (curved arrow) and VIII (open arrow). (c) CT scan through the porta hepatis shows a nonocclusive thrombus bridging the right and left portal veins (straight arrow) and the occlusive thrombus in segment VII (curved arrow). (d) CT scan through the lower portion of the liver shows occlusive thrombi in segment V (arrowheads).

View larger version (154K): [in a new window]   Figure 1d. Transverse contrast medium-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows occlusive thrombi in segments VII (solid arrow) and VIII (open arrows). (b) CT scan obtained just caudal to a shows an occlusive left portal vein thrombus (straight solid arrow), as well as the occlusive thrombi in segments VII (curved arrow) and VIII (open arrow). (c) CT scan through the porta hepatis shows a nonocclusive thrombus bridging the right and left portal veins (straight arrow) and the occlusive thrombus in segment VII (curved arrow). (d) CT scan through the lower portion of the liver shows occlusive thrombi in segment V (arrowheads).

View larger version (137K): [in a new window]   Figure 2a. Transverse contrast-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows a nonocclusive thrombus in segment VIII (arrow). (b) CT scan through the porta hepatis shows nonocclusive thrombus in the left portal vein (arrow).

View larger version (136K): [in a new window]   Figure 2b. Transverse contrast-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows a nonocclusive thrombus in segment VIII (arrow). (b) CT scan through the porta hepatis shows nonocclusive thrombus in the left portal vein (arrow).

View larger version (147K): [in a new window]   Figure 3a. Transverse contrast-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows a segment VIII portal vein branch that is normally enhanced (arrow). (b) CT scan obtained just caudal to a shows a nonocclusive thrombus (arrow) in the segment VIII portal vein branch. (c) CT scan obtained just caudal to b shows a normally enhancing segment VIII portal vein branch (straight arrow). There is also a nonocclusive thrombus in the segment VII portal vein branch (curved arrows).

View larger version (151K): [in a new window]   Figure 3b. Transverse contrast-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows a segment VIII portal vein branch that is normally enhanced (arrow). (b) CT scan obtained just caudal to a shows a nonocclusive thrombus (arrow) in the segment VIII portal vein branch. (c) CT scan obtained just caudal to b shows a normally enhancing segment VIII portal vein branch (straight arrow). There is also a nonocclusive thrombus in the segment VII portal vein branch (curved arrows).

View larger version (148K): [in a new window]   Figure 3c. Transverse contrast-enhanced CT scans through the liver obtained during the portal venous phase. (a) CT scan through the upper portion of the liver shows a segment VIII portal vein branch that is normally enhanced (arrow). (b) CT scan obtained just caudal to a shows a nonocclusive thrombus (arrow) in the segment VIII portal vein branch. (c) CT scan obtained just caudal to b shows a normally enhancing segment VIII portal vein branch (straight arrow). There is also a nonocclusive thrombus in the segment VII portal vein branch (curved arrows).

View larger version (143K): [in a new window]   Figure 4. Transverse contrast-enhanced CT scan through the liver obtained during the portal venous phase. CT scan through the lower portion of the liver, acquired with narrow windows, shows a wedge-shaped area of hyperenhancement (straight arrows) in segment V distal to occlusive segmental vein thrombus (arrowheads). The image also shows how an intrahepatic bile duct (curved arrow) next to an opacified portal vein branch can be distinguished from a segmental thrombus.