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Jiang T, Aji T, Ran B, Guo Q, Zhang R, Ahan A, Abulizi A, Tuergan T, Shao Y, Wen H. Collateral circulation caused by end-stage hepatic alveolar echinococcosis. BMC Infect Dis 2023; 23:322. [PMID: 37189056 DOI: 10.1186/s12879-022-07970-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/23/2022] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Hepatic alveolar echinococcosis (HAE), as a benign parasitic disease with malignant infiltrative activity, grows slowly in the liver, allowing sufficient time for collateral vessels to emerge in the process of vascular occlusion. METHODS The portal vein (PV), hepatic vein and hepatic artery were observed by enhanced CT and the inferior vena cava (IVC) by angiography, respectively. Analysis of the anatomical characteristics of the collateral vessels helped to look into the pattern and characteristics of vascular collateralization caused by this specific etiology. RESULTS 33, 5, 12 and 1 patients were included in the formation of collateral vessels in PV, hepatic vein, IVC and hepatic artery, respectively. PV collateral vessels were divided into two categories according to different pathways: type I: portal -portal venous pathway (13 cases) and type II: type I incorporates a portal-systemic circulation pathway (20 cases). Hepatic vein (HV) collateral vessels fell into short hepatic veins. The patients with IVC collateral presented with both vertebral and lumbar venous varices. Hepatic artery collateral vessels emanating from the celiac trunk maintains blood supply to the healthy side of the liver. CONCLUSIONS Due to its special biological nature, HAE exhibited unique collateral vessels that were rarely seen in other diseases. An in-depth study would be of great help to improve our understanding related to the process of collateral vessel formation due to intrahepatic lesions and its comorbidity, in addition to providing new ideas for the surgical treatment of end-stage HAE.
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Affiliation(s)
- Tiemin Jiang
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
- The First Clinical Medical College of Xinjiang Medical University, Urumqi, 830054, China
| | - Tuerganaili Aji
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Bo Ran
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Xinjiang Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiang Guo
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Ruiqing Zhang
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Xinjiang Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ayifuhan Ahan
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Abuduaini Abulizi
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Talaiti Tuergan
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Yingmei Shao
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China.
- Xinjiang Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China.
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.
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Cai SF, Gai YH, Ma S, Liang B, Wang GC, Liu QW. Ultrasonographic Visualization of Accessory Hepatic Veins and Their Lesions in Budd-Chiari Syndrome. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2091-2098. [PMID: 25952161 DOI: 10.1016/j.ultrasmedbio.2015.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 02/13/2015] [Accepted: 03/19/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to investigate the ultrasonographic features of accessory hepatic veins (AHVs) and their lesions in Budd-Chiari syndrome (BCS). Three hundred patients with BCS were examined by ultrasonography with multifrequency (3-6 MHz) convex transducers. Sonography was performed 1 to 2 wk before digital subtraction angiography and computed tomography angiography or magnetic resonance imaging. Using sonograms, we evaluated the number, course, diameter, orifice, lesions and hemodynamics of patent and obstructed AHVs. Ultrasonography was superior to digital subtraction angiography, computed tomography angiography and magnetic resonance imaging in revealing AHV lesions and hemodynamics. Dilated AHVs were detected in 227 patients. There were 239 caudate lobe veins in 167 patients and 168 inferior right hepatic veins in 151 patients. Both caudate lobe veins and inferior right hepatic veins were found in 91 of the 227 patients. The inlets to AHVs were located mainly on the right lateral or right anterior wall of the inferior vena cava, and the remnant, on the left lateral wall. AHV lesions comprised mainly septal obstruction and segmental stenosis. The hemodynamics of AHVs varied with the condition of inferior vena cava and AHVs. Ultrasonic examination can reveal AHVs and their lesions in patients with BCS and is helpful in choosing and planning therapeutic approaches.
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Affiliation(s)
- Shi-Feng Cai
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, Jinan City, Shandong Province, China
| | - Yong-Hao Gai
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong University, Jinan City, Shandong Province, China
| | - Shuang Ma
- Department of Ultrasound, Fifth Hospital of Jinan, Jinan City, Shandong Province, China
| | - Bo Liang
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong University, Jinan City, Shandong Province, China
| | - Guang-Chuan Wang
- Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, Jinan City, Shandong Province, China
| | - Qing-Wei Liu
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, Jinan City, Shandong Province, China.
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Cai SF, Gai YH, Liu QW. Computed tomography angiography manifestations of collateral circulations in Budd-Chiari syndrome. Exp Ther Med 2014; 9:399-404. [PMID: 25574205 PMCID: PMC4280983 DOI: 10.3892/etm.2014.2125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 10/21/2014] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to assess the computed tomography angiography (CTA) manifestations of collateral circulations in patients with Budd-Chiari syndrome (BCS). Eighty patients with BCS were examined by CT scan. Using the CTA images of the relevant blood vessels, including the affected hepatic veins (HVs) and inferior venae cavae (IVCs), the collateral circulations were reconstructed. In addition to obstructed HVs and IVCs, collateral circulations were found in each of the patients. The collateral circulations were classified as intrahepatic, extrahepatic and portosystemic pathways. Intrahepatic collateral pathways were further classified as the following six types: HV-accessory HV (n=51, 63.8%), HV-HV (n=6, 7.5%), HV-accessory HV plus HV (n=6, 7.5%), IVC-HV/accessory HV-HV-right atrium (n=5, 6.3%), HV-umbilical vein (n=4, 5.0%) and HV-inferior phrenic vein (n=8, 10.0%). Extrahepatic collateral pathways included IVC-lumbar-ascending lumbar-hemiazygos/azygos vein (n=80, 100.0%), IVC-left renal-ascending lumbar-hemiazygos vein (n=75, 93.8%), IVC-left renal-inferior phrenic vein (n=49, 61.3%), IVC-renal -peri-renal -superficial epigastric vein (n=26, 32.5%) and superficial epigastric vein (n=12, 15.0%) types. The CTA characteristics of each type of collateral circulation were demonstrated. In conclusion, the present study revealed that CTA is able to show the intra- and extrahepatic collateral circulations of patients with BCS, which may be useful for therapeutic planning.
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Affiliation(s)
- Shi-Feng Cai
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yong-Hao Gai
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Qing-Wei Liu
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Gai YH, Cai SF, Fan HL, Liu QW. Diagnosis of the cavo-hepato-atrial pathway in Budd-Chiari syndrome by ultrasonography. Exp Ther Med 2014; 8:793-796. [PMID: 25120601 PMCID: PMC4113649 DOI: 10.3892/etm.2014.1828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/13/2014] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to investigate the ultrasonic features of the cavo-hepato-atrial pathway in Budd-Chiari syndrome (BCS), by which blood is drained from the occluded inferior vena cava (IVC) to the right atrium via hepatic veins. Ultrasonograms from 11 patients with BCS with cavo-hepato-atrial pathways were retrospectively studied. Doppler ultrasound was used to observe the direction of the flow and measure the velocity of the blood-draining vessels. Blood flow in the draining vessels and the collaterals was shown as blue, red or bicolored depending on whether the flow direction was away from the transducer, towards the transducer or both. For measurement, the Doppler angle between the axis of the Doppler beam and that of the vein examined was always <60°. Ultrasonography was performed 1–2 weeks prior to digital subtraction angiography (DSA). All patients were confirmed by DSA. Membranous and segmental occlusions of IVCs were observed in seven and four cases, respectively. Blood flow from the IVC reversed to the hepatic/accessory hepatic vein, continued through the dilated intrahepatic collaterals, onward to the other hepatic vein and finally to the right atrium. The majority of the inlets (8/11) of hepatic veins above the occlusion were narrow compared with the dilated distant parts of the lumens. Accelerated blood flow in the inlets was detected in all patients regardless of the luminal diameter. In conclusion, the results from the present study suggest that the unusual cavo-hepato-atrial pathway can be diagnosed reliably by ultrasonography, which may be useful for clinical management.
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Affiliation(s)
- Yong-Hao Gai
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Shi-Feng Cai
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Hui-Li Fan
- Department of Ultrasound, Heze Municipal Hospital, Heze, Shandong 274000, P.R. China
| | - Qing-Wei Liu
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Gai YH, Cai SF, Guo WB, Zhang CQ, Liang B, Jia T, Zhang GQ. Sonographic classification of draining pathways of obstructed hepatic veins in Budd-Chiari syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:134-142. [PMID: 24166054 DOI: 10.1002/jcu.22107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/30/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE To describe and propose a sonographic classification of the blood-draining pathways of obstructed hepatic veins in Budd-Chiari syndrome. METHODS This retrospective study included 206 patients with hepatic vein obstructions who underwent sonographic examination. We evaluated the afflicted hepatic veins, as well as the course, orifice, blood flow direction of draining veins, and communicating branches. Results were classified and compared with digital subtraction angiography and computed tomography angiography. RESULTS Of 618 hepatic veins in 206 patients, 542 were obstructed. The blood-draining pathways were classified as hepatic vein-accessory hepatic vein (131/206), hepatic vein-hepatic vein/accessory hepatic+hepatic vein (49/206), and, less frequently, collateral pathways (26/206). Blood was drained from obstructed hepatic veins to the inferior vena cava, right atrium, para-umbilical veins, or hepatic subcapsular veins through communicating branches of various number and diameters. Doppler signals were obtained from the draining veins. CONCLUSIONS Sonography provides accurate information regarding the blood-draining pathways of obstructed hepatic veins in Budd-Chiari syndrome, which may be helpful for treatment and follow-up.
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Affiliation(s)
- Yong-Hao Gai
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, China
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Kapur S, Paik E, Rezaei A, Vu DN. Where There Is Blood, There Is a Way: Unusual Collateral Vessels in Superior and Inferior Vena Cava Obstruction. Radiographics 2010; 30:67-78. [DOI: 10.1148/rg.301095724] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lu SM, Duan ZJ, Liu LN, Zhang W, Wang F, Li F. Atypical Budd-Chiari syndrome induced by rare collateral pathways: one-case analysis. Shijie Huaren Xiaohua Zazhi 2008; 16:3359-3361. [DOI: 10.11569/wcjd.v16.i29.3359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A male patient of fifty-eight years old was diagnosed with cryptogenic cirrhosis in other hospital. However, we concluded it Budd-Chiari Syndrome by multislice spiral computed tomography and inferior vena cavography. He had no clinical manifestations of Budd-Chiari syndrome, such as ascites, varicose veins of lower extremity and pedal edema. Moreover there were rare collateral pathways. The patient's symptom was released and without complication after successful interventional therapy.
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Inomata S, Takeyama Y, Tanaka T, Ueda SI, Morihara D, Nishizawa S, Matsumoto T, Anan A, Nishimura H, Irie M, Iwata K, Shakado S, Sohda T, Higashihara H, Okazaki M, Sakisaka S. Budd-Chiari syndrome: two cases with different courses. Case Rep Gastroenterol 2008; 2:256-61. [PMID: 21490897 PMCID: PMC3075152 DOI: 10.1159/000146063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report two cases of Budd-Chiari syndrome. Case 1: A 57-year-old man presented with leg edema and esophageal varices. Cavography showed obstruction of the inferior vena cava with antiphospholipid syndrome. Further, the patient showed positive serology for hepatitis C virus and consumed large quantities of alcohol. Percutaneous transluminal angioplasty was performed on this patient and anticoagulants administered; leg edema and esophageal varices were ameliorated although liver biopsy showed cirrhosis without evident congestion. More than 9 months since the diagnosis, restenosis of the inferior vena cava has not occurred. Case 2: A 73-year-old woman presented abdominal pain but no edema or varices. Cavography showed membranous obstruction of the inferior vena cava which required no therapy. Manifestation of portal hypertension was not present and liver function was maintained although liver biopsy showed obvious congestion. These cases showed untypical features against histopathology, and careful observation will be required for emergence of hepatocellular carcinoma.
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Affiliation(s)
- Shinjiro Inomata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Pathare HP, Biniwale RM. Balloon Dilatation of Membranous Obstruction of the Inferior Vena Cava. Asian Cardiovasc Thorac Ann 1998. [DOI: 10.1177/021849239800600218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Membranous obstruction of the inferior vena cava is a rare congenital anomaly that results in the primary type of Budd-Chiari syndrome. We describe the case of an 8-year-old boy initially diagnosed with intrahepatic portal hypertension, who underwent percutaneous transluminal balloon dilatation of an inferior vena cava membrane located in the suprahepatic inferior vena cava, which resulted in successful palliation of his symptoms.
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Affiliation(s)
- Hemant Pramod Pathare
- PK Sen Department of Cardiovascular & Thoracic Surgery Seth GS Medical College & King Edward VII Memorial Hospital Mumbai, India
| | - Reshma Manoj Biniwale
- PK Sen Department of Cardiovascular & Thoracic Surgery Seth GS Medical College & King Edward VII Memorial Hospital Mumbai, India
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