Crido Silvina,  Bravo Monica,  Lipsich Jose,  Cermeño Claudia,  Dardanelli Esteban,  Moguillanky Slvia

Final Pr. ID: Poster #: EDU-029

To present a series of patients with pylephlebitis without a significant past medical history Read More

Authors:  Crido Silvina , Bravo Monica , Lipsich Jose , Cermeño Claudia , Dardanelli Esteban , Moguillanky Slvia

Keywords:  Pylephlebitis, portal vein thrombosis, omphalitis, appendicitis, ultrasonography

Khan Muhammad,  Prasad Preeti,  Sandhu Preet

Final Pr. ID: Poster #: EDU-014

Abnormalities of the portal venous system are a heterogenous group which include congenital anomalies and changes in portal vein secondary to iatrogenic causes or inflammatory and neoplastic conditions. Detailed knowledge of the normal embryology, anatomy of the portal vein and its variants is crucial in the understanding of portal vein anomalies. Identification of normal or variant portal vein anatomy is important part of pre surgical and pre liver transplant evaluation and helps minimize post-surgical/interventional complications. Read More

Authors:  Khan Muhammad , Prasad Preeti , Sandhu Preet

Keywords:  portal vein, congenital, anomalies

Khan Hasan,  Hernandez Alberto,  Chau Alex,  Akhtar Zahra,  Upton Ashley

Final Pr. ID: Poster #: SCI-027

This study aims to evaluate the efficacy and impact of portal vein interventions in pediatric patients; which includes recanalization with venoplasty or stenting and their effects on hepatic and splenic hemodynamics through pre- and post-procedural liver and spleen elastography. Read More

Authors:  Khan Hasan , Hernandez Alberto , Chau Alex , Akhtar Zahra , Upton Ashley

Keywords:  Elastography, Portal Hypertension, Portal Vein Thrombosis

Vegunta Aishwariya

Final Pr. ID: Poster #: EDU-037

A pictorial review of imaging appearances of anatomic variations of the portal vein.
Classification and pictorial review of various congenital abnormalities of the portal vein.
Common variations and branching patterns include trifurcation of the main PV, right posterior segmental branch arising from the main PV, and right anterior segmental branch arising from the left PV. Other less common branching patterns include left PV arising from the right anterior segmental branch, duplication of PV and absent branching of PV.
Portal venous shunts may be either portosystemic shunts with abnormal communication between the portal and systemic venous systems or arterioportal shunts between portal venous system and hepatic artery.
Portosystemic shunts bypass the liver and shunt directly portal venous blood into systemic venous system.
Congenital intrahepatic portosystemic shunts are classified into four types based on Park et al. Type I, the most common type, a single vessel connects the right portal vein to the IVC. Type II in which peripheral shunt localized to one hepatic segment and single or multiple communications between branches of portal and hepatic veins. Type III with aneurysmal connection between portal and hepatic veins. Type IV with multiple communications between peripheral portal and hepatic veins in several segments.
Abernethy malformations/congenital extrahepatic portosystemic shunts can be divided into 2 major types. Type I with complete absence of intrahepatic portal venous flow and complete shunting. Type Ia with congenital absence of the portal vein and separate drainage of superior mesenteric vein and splenic vein into systemic veins. Type IIb in which superior mesenteric vein and splenic vein join to form a short extrahepatic portal vein which drains into a systemic vein. Type II with some preserved hepatic portal venous flow and partial shunting. Type IIa arising from left or right portal vein including patent ductus venosus. Type IIb arising from main portal vein. Type IIc arising from the other portal vein tributaries. Patients with both these types suffer premature mortality either due to shunting complications or other associated congenital abnormalities.
Congenital arterioportal shunts may present either as a fistula or as vascular malformations in hereditary hemorrhagic telangiectasia.
Aneurysms of the PV may represent approximately 3% of all aneurysms of the venous system. Read More

Authors:  Vegunta Aishwariya

Keywords:  Portal vein, Congenital intrahepatic portosystemic shunts, Abernethy malformations/congenital extrahepatic portosystemic shunts

Stein Nina,  Ahmed Fahran

Final Pr. ID: Poster #: CR-066

We present a radiologic case of a teenager with portal, inferior mesenteric, superior mesenteric, and splenic vein thromboses presenting with acute abdominal pain and treated conservatively with anticoagulation therapy. Ultrasound and computed tomography were done at the acute presentation and follow up magnetic resonance images were performed. One year of anticoagulation therapy correlated with almost complete resolution of splanchnic thrombosis; however, the superior mesenteric vein continues to remain severely dilated close to the confluence on subsequent annual imaging. The initial imaging also diagnosed multiple phlebolith in the pelvis. We suspect this is a congenital malformation of the porto-splanchnic circulation presenting with acute thrombosis. Differential is variceal dilatation as sequela of extensive thrombosis. Read More

Authors:  Stein Nina , Ahmed Fahran

Keywords:  Splanchnic Venous Thrombosis, Portal Venous Aneurysm, Mesenteric Vein Thrombosis, Portal Vein Thrombosis, Anticoagulation

Cregg Allison,  Nguyen Theo,  Holm Tara,  Flanagan Siobhan

Final Pr. ID: Poster #: CR-059

Portal hypertension in pediatric patients is rare, most commonly caused by extrahepatic portal vein (PV) occlusion. Complications include gastrointestinal bleeding. If obstruction recanalization or surgical shunt is not feasible, a transjugular intrahepatic portosystemic shunt (TIPS) can be placed. Risks of TIPS include encephalopathy, shunt stenosis, or thrombosis. Tipsitis is rare, occurring in less than 1% of TIPS patients, but is serious, with a mortality of 32%. Early diagnosis and treatment are key to preventing the need for liver transplantation, and imaging plays a key role in early detection. We present a case of tipsitis identified with FDG-PET/CT imaging.
A 16 year-old-male with prematurity, umbilical vein catheter, and heterozygous prothrombin mutation presented with hematemesis. Imaging identified chronic PV thrombosis. Due to the occlusion involving both the right and left PV, TIPS was placed. 5.5 months post-TIPS, he presented with fever and body aches. Investigations revealed Methicillin-Sensitive Staphylococcus aureus (MSSA) bacteremia and thrombosed TIPS. He completed a 6-week course of IV antibiotics, and the TIPS was revised.
Two weeks later, he was readmitted with recurrent MSSA bacteremia. FDG-PET/CT scan was performed, showing increased TIPS uptake, consistent with tipsitis. He completed an additional 8-week IV antibiotic course. Repeat FDG-PET/CT showed decreased but persistent TIPS uptake. IV antibiotics were extended, and he was placed on suppressive oral antibiotics with a plan for FDG-PET/CT in 3 months.
Tipsitis is rare, and early infection (<120 days) is associated with gram-positive bacteria caused by seeding during placement. In this case, later infection was suspected to be caused by Staph aureus superinfection during influenza. Low-grade symptoms include malaise, and high-grade symptoms include fever and rigors. Suspicious CT findings include peri-graft gas or fluid. Radiolabeled leukocyte uptake is specific to infection, but spatial resolution is limited. FDG-PET/CT with focal TIPS metabolic activity (SUV > 8.0) correlates with infection source (sensitivity 91-98%, specificity 64–91%).
Antibiotic therapy is successful in 53% of cases, and FDG-PET/CT can determine the degree of treatment success. Residual hypermetabolic activity signifies partial response. Aggressive antibiotics are recommended to prevent resistance and the need for liver transplant. FDG-PET/CT plays a vital role in diagnosis and management of tipsitis. Read More

Authors:  Cregg Allison , Nguyen Theo , Holm Tara , Flanagan Siobhan

Keywords:  Portal Vein Thrombosis, FDG PET, Interventional Radiology

Panesar Harsimran,  Beekman Alexander,  Martin Laura,  Armstrong Katherine,  Hodes Aaron

Final Pr. ID: Poster #: CR-006

Midgut volvulus in children is uncommon, but diagnosis of portal vein thrombosis in association with midgut volvulus has been rarely reported. We present a case of a 3-year old male with an unusual presentation of recurrent episodic abdominal pain suspected initially having ileocolic intussusception. Cross-sectional imaging identified extensive acute portomesenteric thrombosis in the setting of suspected midgut volvulus, which was confirmed on upper GI series and at surgery. A thrombophilia workup was negative. To our knowledge, this is the first case of acute portal vein and superior mesenteric vein thrombosis with splenic vein extension in association with midgut volvulus. When the diagnosis remains elusive and imaging demonstrates an extensive acute PVT with SMV extension in children and adolescents, radiologists should consider midgut volvulus in addition to other etiologies, such as malignancy, cirrhosis, or bowel inflammation. Read More

Authors:  Panesar Harsimran , Beekman Alexander , Martin Laura , Armstrong Katherine , Hodes Aaron

Keywords:  Portal vein thrombosis, Superior mesenteric vein thrombosis, Midgut volvulus