Imaging and radiological interventions in extra-hepatic portal vein obstruction

• 作者: Amar Mukund Ankur Arora S Rajesh Saloni N Desai Sudheer S Pargewar Vaibhav P Singh
• 来源期刊: 世界放射学杂志：英文版（电子版）
• 学科: 医学
• 关键词: EXTRAHEPATIC PORTAL venous OBSTRUCTION PORTAL CAVERNOMA PORTAL hypertension Transjugular INTRAHEPATIC portosystemic shunt SPLENIC embolization
• 年，卷（期）: 2016,（6）
• 页码范围: 556-570
• 页数: 15页
• 分类号: R725.7

摘要

Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension(PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt(PSS) and revision of PSS.