Splenic vein thrombosis is a blood clot that is obstructing the splenic vein, which is located on the surface of the spleen. Splenic vein thrombosis is uncommon and is usually described in relation to abdominal disease such as pancreatitis or trauma. Figure 3. Although risk factors like portal hypertension and liver cirrhosis have been highlighted, the etiology remains to be clarified. Bastarrika G, Bilbao JI, Martnez-Cuesta A, Elorz M, Vivas I . A normal splenic vein doppler will make the diagnosis of splenic vein thrombosis highly improbable. The intrahepatic IVC and the three main hepatic veins are also interrogated . In patients without cirrhosis, the contrast medium rarely refluxes caudad in the portal vein but progresses cephalad through the liver. 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 ). Electronic address: urossi76@hotmail.com. 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 . Once completed, the imaging referral form should be faxed to: 020 3594 3199. 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. National Locums. 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 . 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). The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. Link 31 Jan 1 note Portal and Splenic Vein Thrombosis nickthejam liked this radiologyreview posted this It runs in the splenorenal ligament in close association with the splenic artery . Splenic Vein Aneurysm: A Rare and Incidental Finding 2926. 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 addition to the spleen, it drains parts of the stomach, pancreas and the hindgut. Morphologically there are three types of venous aneurysms: fusiform, saccular and diverticular [2]. 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. Mohy-ud-din, Nabeeha MD; Bedi, Gurneet MD; Garg, Mrinal MD; Dhawan, Manish MD. In postcholecystectomy patients up to 10mm is normal. Find similar topics on :: Scholar:: Radiology search engine 6. Allegheny Health Network, Pittsburgh, PA. American Journal of Gastroenterology: October 2018 - Volume 113 - Issue - p S1611-S1612. Behind the neck of the pancreas, it confluences with the superior mesenteric vein to form the portal vein. 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. Overview. Its tributaries include the short gastric, left gastroepiploic, pancreatic, and inferior mesenteric veins (see Fig. 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. View chapter Purchase book Intrahepatic bile ducts: <2mm is normal. While the literature on this topic is scarce, it seems that the consensus is that if splenic vein thrombosis is associated with portal hypertension, gastric or esophageal varices than splenectomy should be . Evaluation of the viability of the splenic parenchyma, including any areas of infarction, is important as it guides therapy. 12-3 ). New magnetic resonance (MR) imaging techniques have increased the role of MR imaging in detection and characterization of splenic diseases. The mechanism of splenic rupture in infectious mononucleosis is not completely understood. Additionally, splenic lesion biopsy confirmed a diagnosis of NHL. Computed tomography scan demonstrating a 2.5 cm density in the pancreatic tail . The majority of primary splenic NHL originates from B cells, characterizing splenomegaly. Compared with other imaging examinations, PET/CT has a high sensitivity for NHL lesions. Splenic vein (vena splenica) The splenic vein is a large vessel located retroperitoneally in the upper part of the abdominal cavity. The main function of this blood vessel is to drain the venous blood from the spleen. MR imaging is an excellent tool for diagnosis and evaluation of focal lesions and pathologic conditions of the spleen. It should be noted that the tortuous splenic veins frequently seen at the hilum of the enlarged spleen should not be called perisplenic varices. In mesenteric venous thrombosis, studies have shown that a CT scan of the abdomen has 90 percent accuracy. (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). It is associated with complications of significant gastrointestinal bleeding and high morbidity if the thrombus propagates. To the best of our knowledge, this represents the second reported case of an anteriorly placed splenic vein. The natural course of splenic vein aneurysms is uncertain and because of this condition, the timing and type of treatment remain controversial . Splenic vein thrombosis is rarely diagnosed with certainty prior to surgery or autopsy. Epidemiology However, various other cancers, such as colon, gastric, or renal cancers, have also been known to cause splenic vein occlusion. 2 Departamento de Imagen Diagnstica, Unidad de . Affiliations 1 Departamento de Imagen Diagnstica, Unidad de Radiologa Interventiva, E.O. 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. 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. Author Information . Portal imaging includes the main portal vein, the right and left intrahepatic portal vein branches, and the splenic vein. As such, the differential diagnosis and subsequent management are based primarily on imaging characteristics. 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 . 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). Sinistral Portal Hypertension; imaging findings and endovascular therapy. Splenic . 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. The inferior mesenteric vein is the biggest vein which drains into the splenic vein (variance of 30 % into the superior mesenteric vein). Interventional radiology . It also treats the painfully enlarged spleen/hypersplenism and is preferred in adult patients. gamna-gandy bodies in spleen gamna-gandy bodies in spleen gamna-gandy bodies in spleen 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 . Both penetrating and non-penetrating injury to the epigastric area result in injury to the left lobe of the liver. Clinical Cases Authors. Once in the liver, PV ramifies and reaches the sinusoids, with downstream blood being directed to the central vein at . In paediatric patients, 4mm is upper limit. 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. Case Type. Am J Surg 2008;196, 149 -154. 96-7 ). Variant anatomy Anomalies of hepatic artery origin and number are common 10,20-23 ( Table 12-2 ). Splenic varices usually traverse the splenocolic ligament and are seen as dilated veins in the anteroinferior aspect of the spleen [ 20 ]. The computed tomographic (CT) findings in 18 patients with angiographically proved, isolated splenic vein occlusion (SVO) were retrospectively analyzed. Short gastric and . Edema, increase in cell size and lifting of the splenic capsule would suggest that stretching of the capsule may result in spontaneous hemorrhage. View similar jobs: Consultant Radiology Jobs in London; Jobs in London; Consultant In Gynaecology Radiology - Central London Save. The branches of the splenic vein, which converge at the splenic hilus, are more readily identified. 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. The splenic vein lies behind the upper border of the pancreas below the splenic artery (see Fig. Clinical data were reviewed for sequela of SVO and clinical impact of the diagnosis. Once completed, the imaging referral form should be faxed to: 020 3594 3199. Figure 2. Splenic vein thrombosis (SVT) is a well-recognized complication of acute and chronic pancreatitis. London We offer you Autonomy, Flexibility . Abdom Imaging Find similar topics on :: Scholar:: Radiology search engine 5. Results Note the hyperechoic capsule on the far border of the spleen. Thus, the radiologist must . Splenomegaly appears to be a common accompaniment of splenic rupture in this disorder as seen in our case. The Doppler US findings seen in the complications described are often subtle and nonspecific and may evolve over time. 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. 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. There is a need to consider several factors in choosing whether to anticoagulate the patient. When wandering spleen is suspected, radiologic imaging should locate the ectopic spleen and evaluate the anatomy and patency of the splenic vessels. Normal diameter < 7 mm. Splenic vein thrombosis may result in portal hypertension. For imaging and Dexa scan referral forms please visit the dedicated referral section on our website. A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. In 1956 . Most common sites are the main portal vein and confluence of splenic and superior mesenteric veins, forming extra-hepatic portal vein aneurysm (EPVA). 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. It can detect not only infringed lymph nodes but also pathological changes outside the junction.
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