CT angiography and Doppler ultrasound evaluation of congenital portosystemic shunts

Yıl 2022, Cilt: 6 Sayı: 1, 9 - 14, 27.03.2022

İsmail Akdulum , Melih Akyüz , Enes Gürün , Mehmet Öztürk , Ahmet Sığırcı , Öznur Boyunağa

https://doi.org/10.30565/medalanya.828133

Cited By: 1

Öz

Aim: The aim of the study was to describe the Doppler ultrasonography and computed tomography findings that should be considered in the diagnosis and treatment of congenital portosystemic shunts.

Methods: Archive retrospectively scanned. In consideration of shunts: communication type and aneurysm were defined. Additional imaging modalities were utilized.

Results: 11 patients were included in the study. The ages ranged from 0 to 158 months. There were two patients with shunt connecting segment-4 portal vein - middle hepatic vein, two patients with segment-3 portal vein - left hepatic vein, two patients with left portal vein – middle hepatic vein, two patients with portal vein - left renal vein, two patients with portal vein -inferior vena cava, and one patient with portal vein - perirectal venous plexus.

Conclusion: Some classifications used in congenital portosystemic shunts are insufficient in guiding treatment. Elaborate definition of the imaging findings including the involved vessels, type of communication, and presence of aneurysm or dilated vessels is of the prime importance for tailoring clinical management of the patients. 

Anahtar Kelimeler

Congenital portosystemic shunt, Computed tomography, Doppler ultrasonography

Konjenital portosistemik şantların BT anjiyografi ve doppler ultrason ile değerlendirilmesi

Öz

Amaç: Konjenital portosistemik şantların tanısında ve tedavinin yönlendirilmesinde dikkat edilmesi gereken Doppler ultrasonografi ve Bilgisayarlı tomografi bulgularını tanımlamaktır.

Yöntem: Arşiv geriye dönük olarak taranmıştır. Şantlar göz önüne alındığında: bağlantı tipi ve anevrizma varlığı tanımlandı. Ek görüntüleme yöntemleri varsa not edildi.

Bulgular: Çalışmaya 11 hasta dahil edildi. Yaşlar 0 ile 158 ay arasında değişiyordu. Şant bağlantısı segment-4 portal ven - orta hepatik ven olan iki hasta, segment-3 portal ven - sol hepatik ven olan iki hasta, sol portal ven - orta hepatik ven olan iki hasta, portal ven - sol renal ven olan iki hasta, portal ven - inferior vena kava olan iki hasta ve portal ven - perirektal venöz pleksuslu bir hasta vardı.

Sonuç: Konjenital portosistemik şantlarda kullanılan bazı sınıflamalar tedavi yönlendirmesinde yetersiz kalmaktadır. İlgili damarlar, iletişim tipi ve anevrizma veya dilate damarların varlığı dahil olmak üzere görüntüleme bulgularının ayrıntılı tanımı, hastaların klinik yönetiminin özelleştirilmesi için birincil öneme sahiptir.

Anahtar Kelimeler

Konjenital Portosistemik Şant, Bilgisayarlı Tomografi, Doppler Ultrasonografi

Kaynakça

• 1. Bernard O, Franchi-Abella S, Branchereau S, Pariente D, Gauthier F, Jacquemin E, Congenital portosystemic shunts in children: recognition, evaluation, and management. Semin Liver Dis. 2012;32(4):273-87. DOI: 10.1055/s-0032-1329896.
• 2. De Gaetano AM, Rinaldi P, Barbaro B, Mirk P, Di Stasi C, Gui B, et al. Intrahepatic portosystemic venous shunts: color Doppler sonography. Abdom Imaging. 2007;32(4):463-9. DOI: 10.1007/s00261-006-9068-1.
• 3. Kim MJ, Ko JS, Seo JK, Yang HR, Chang JY, Kim GB, et al. Clinical features of congenital portosystemic shunt in children. Eur J Pediatr. 2012;171(2):395-400. DOI: 10.1007/s00431-011-1564-9.
• 4. Matsuura T, Takahashi Y, Yanagi Y, Yoshimaru K, Yamamura K, Morihana E, et al. Surgical strategy according to the anatomical types of congenital portosystemic shunts in children. J Pediatr Surg. 2016;51(12):2099-104. DOI: 10.1016/j.jpedsurg.2016.09.046.
• 5. Papamichail M, Pizanias M, Heaton N. Congenital portosystemic venous shunt. Eur J Pediatr. 2018;177(3):285-94. DOI: 10.1007/s00431-017-3058-x.
• 6. Filik L, Boyacioglu S. Asymptomatic aneurysmal portosystemic venous shunt: a case report and review of the literature. Acta Medica. 2006;49(4):241-4. DOI: 10.14712/18059694.2017.140.
• 7. Hondo T, Teragawa H, Munemori M, Morishima N, Watanabe H, OGATA S, et al. Portal-hepatic venous shunt through a portal aneurysm complicated by hepatic encephalopathy and pulmonary hypertension. Intern Med. 1997;36(11):790-3. DOI: 10.2169/internalmedicine.36.790.
• 8. Ozbek S, Killi MR, Pourbagher MA, Parildar M, Katranci N, Solak. Portal venous system aneurysms: report of five cases. J Ultras Med. 1999;18(6):417-22; quiz 423. DOI: 10.7863/jum.1999.18.6.417.
• 9. Blanc T, Guerin F, Franchi-Abella S, Jacquemin E, Pariente D, Soubrane O, et al. Congenital portosystemic shunts in children: a new anatomical classification correlated with surgical strategy. Ann Surg. 2014;260(1):188-98. DOI: 10.1097/SLA.0000000000000266.
• 10. Kanazawa H, Nosaka S, Miyazaki O, Sakamoto S, Fukuda A, Shigeta T, et al. The classification based on intrahepatic portal system for congenital portosystemic shunts. J Pediatr Surg. 2015;50(4):688-95. DOI: 10.1016/j.jpedsurg.2015.01.009.
• 11. Franchi-Abella S, Gonzales E, Ackermann O, Branchereau S, Pariente D, Guérin F; Congenital portosystemic shunts: diagnosis and treatment. International Registry of Congenital Portosystemic Shunt members. Abdom Radiol (NY). 2018;43(8):2023-2036. DOI: 10.1007/s00261-018-1619-8.
• 12. DiPaola F, Trout AT, Walther AE, Gupta A, Sheridan R, Campbell KM, et al. Congenital Portosystemic Shunts in Children: Associations, Complications, and Outcomes. Dig Dis Sci. 2020;65(4):1239-51. DOI: 10.1007/s10620-019-05834-w
• 13. Kobayashi N, Niwa T, Kirikoshi H, Fujita K, Yoneda M, Saito S, et al. Clinical classification of congenital extrahepatic portosystemic shunts. Hepatol Res. 2010;40(6):585-93. DOI: 10.1111/j.1872-034X.2010.00667.x
• 14. Park JH, Cha S, Han JK, Han MA. Intrahepatic portosystemic venous shunt. AJR Am J Roentgenol. 1990;155(3):527-8. DOI: 10.2214/ajr.155.3.2117349.
• 15. Abernethy JJPTotRSoL. IX. Account of two instances of uncommon formation, in the viscera of the human body. 1793;(83):59-66. DOI: 10.1098/rstl.1793.0010.