Purpose or Case Report: Cavernous transformation of the portal vein (CTPV) is characterized by the formation of venous channels within and around a previously stenosed or occluded portal vein, serving as portoportal collateral vessels. It is a major cause of portal hypertension in children and requires a multifaceted management approach, including medical therapy, interventional procedures such as portal recanalization, and surgical treatments ranging from shunt creation to liver transplantation in end-stage cases.
CT-angiography, in combination with portal venography, is the key imaging modality for determining the optimal treatment strategy. It is essential not only for assessing liver cirrhosis and secondary signs of portal hypertension—such as portosystemic collaterals, splenomegaly, and ascites—but also for providing detailed anatomical mapping critical for surgical planning.
This presentation will illustrate various pediatric cases of CTPV and discuss the optimal management approach based on factors including the presence or absence of liver cirrhosis, dominant portal collaterals, intrahepatic portal flow, proper superior mesenteric vein communicating with the porta hepatis, and splenorenal shunts, among others. For each scenario a therapeutic plan will be suggested based upon clinical and imaging criteria.
By the end of this presentation, readers will be able to: Optimize CT protocols for evaluating CTPV; enhance reporting using a structured checklist of key findings; and support clinical decision-making in collaboration with multidisciplinary teams.
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