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Ochi T, Sakairi Y, Yusa J, Sata Y, Toyoda T, Inage T, Tanaka K, Suzuki H, Ota J, Kondo T, Kato N, Yoshino I. Surgical treatment of a large portopulmonary venous anastomosis in a patient with portal vein thrombosis. JTCVS Tech 2024; 23:158-160. [PMID: 38351989 PMCID: PMC10859668 DOI: 10.1016/j.xjtc.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Takahiro Ochi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Jotaro Yusa
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuki Sata
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahide Toyoda
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Joji Ota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Japan
- Ultrasound Center, Chiba University Hospital, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Japan
- Ultrasound Center, Chiba University Hospital, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Thoracic Surgery, International University Health and Welfare School of Medicine, Narita, Japan
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Power SP, Bishay K, May GR, Marcuzzi D, Prabhudesai V. Portopulmonary venous anastomosis as a rare cause of embolic stroke following endoscopic cyanoacrylate injection for gastric variceal hemorrhage: A case report and review of the literature. JGH Open 2020; 4:99-102. [PMID: 32055706 PMCID: PMC7008152 DOI: 10.1002/jgh3.12180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/06/2019] [Indexed: 02/01/2023]
Abstract
We report the case of a non‐cirrhotic 25‐year‐old female patient with cryptogenic portal hypertension who underwent cyanoacrylate injection for acute gastroesophageal variceal bleeding with a subsequent embolic stroke via a previously unrecognised portopulmonary venous anastomosis.
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Affiliation(s)
- Stephen P Power
- Department of Vascular and Interventional RadiologySt Michael's Hospital Toronto Canada
| | - Kirles Bishay
- Division of GastroenterologySaint Michael's Hospital Toronto Canada
| | - Gary R May
- Division of GastroenterologySaint Michael's Hospital Toronto Canada
| | - Dan Marcuzzi
- Department of Vascular and Interventional RadiologySt Michael's Hospital Toronto Canada
| | - Vikram Prabhudesai
- Department of Vascular and Interventional RadiologySt Michael's Hospital Toronto Canada
- Li Ka Shing Knowledge Institute, Saint Michael's HospitalUniversity of Toronto Toronto Canada
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Matsumoto Y, Hidaka H, Matsunaga K, Kubota K, Yamane K, Inoue T, Minamino T, Takada J, Tanaka Y, Okuwaki Y, Nakazawa T, Shibuya A, Koizumi W. Three-dimensional computed tomography of portopulmonary venous anastomoses in patients with esophageal varices before treatment. Hepatol Res 2016; 46:559-64. [PMID: 26355776 DOI: 10.1111/hepr.12591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 01/03/2023]
Abstract
AIM Portopulmonary venous anastomoses (PPVA) are shunts between esophageal varices and pulmonary veins. Because PPVA can cause serious complications at the time of sclerotherapy for esophageal varices, it is essential to confirm the existence of any PPVA before treatment. METHODS The study group comprised 101 patients in whom hemodynamics were evaluated on three-dimensional computed tomography (3D-CT) before either elective or prophylactic treatment of esophageal varices at Kitasato University East Hospital from October 2007 through August 2013. The presence or absence of PPVA, laboratory test results and 3D-CT findings were retrospectively examined in these patients. RESULTS Nine patients had PPVA, and 92 patients did not. The underlying diseases in the PPVA group were: hepatitis C liver cirrhosis in three; non-B, non-C liver cirrhosis in three; non-alcoholic steatohepatitis in one; primary biliary cirrhosis in one; and autoimmune hepatitis in one. The distribution of underlying diseases did not differ between the PPVA group and the non-PPVA group. When the study variables were statistically compared between the groups, the incidence of large, coil-shaped esophageal varices (grade F3) differed significantly between the groups (P = 0.001). Multivariate analyses of factors related to PPVA revealed that only the grade F3 type of esophageal varices differed significantly between the groups (P = 0.005; hazard ratio, 5.21; 95% confidence interval, 3.1-16.4). CONCLUSION In patients with grade F3 esophageal varices, the treatment method should be selected on the basis of an accurate hemodynamic analysis using 3D-CT before therapy.
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Affiliation(s)
- Yasuhiro Matsumoto
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hisashi Hidaka
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keiji Matsunaga
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kousuke Kubota
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keiko Yamane
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tomoyoshi Inoue
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsutomu Minamino
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Juichi Takada
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshiaki Tanaka
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yusuke Okuwaki
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takahide Nakazawa
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akitaka Shibuya
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Wasaburo Koizumi
- Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Kariya S, Komemushi A, Nakatani M, Yoshida R, Kono Y, Shiraishi T, Tanigawa N. Portopulmonary venous anastomosis in balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices. J Gastroenterol Hepatol 2014; 29:1522-7. [PMID: 24650189 DOI: 10.1111/jgh.12583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Several reports have described portopulmonary venous anastomosis (PPVA). However, in balloon-occluded retrograde transvenous obliteration (BRTO), attention has not been paid to paradoxical embolism. The objective of this study was to investigate the existence of a right-left shunt due to PPVA when the drainage vein is occluded by a balloon during BRTO. METHODS The subjects were 19 patients who underwent BRTO. Whether PPVA was present was confirmed on balloon-occluded retrograde transvenous venography (BRTV). After BRTV, a retrograde bolus injection of 20 mL of carbon dioxide (CO2 ) via the balloon catheter was performed under balloon occlusion, and the flow of bubbles into both ventricles was observed with four-chamber view echocardiography. During the same balloon occlusion, bolus injection of CO2 into the inferior vena cava was performed, followed by echocardiography. RESULTS PPVA was confirmed on BRTV in four patients (21.1%). On echocardiography with retrograde CO2 injection, bubbles were confirmed in the left ventricle in six patients (31.6%). On echocardiography with CO2 injection into the inferior vena cava, bubbles were not confirmed in the left ventricle in any cases. CONCLUSIONS When the draining vein was occluded with a balloon and blood flow in a gastrorenal or gastrocaval shunt was stopped during BRTO, PPVA was confirmed in 21.1% of cases on retrograde angiography, and a right-left shunt was confirmed in 31.6% of cases on echocardiography.
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Affiliation(s)
- Shuji Kariya
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
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5
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Portopulmonary Venous Anastomosis Detected at Balloon-occluded Retrograde Transvenous Obliteration for Gastric Varices. J Vasc Interv Radiol 2013; 24:131-4. [DOI: 10.1016/j.jvir.2012.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/13/2012] [Accepted: 09/15/2012] [Indexed: 11/21/2022] Open
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Gonzalez G, Wilkinson LM, Carcano C, Kumar A, Mohammed TL, Lurix E, Castro F, Kirsch J. Triple-phase abdominal computed tomography for detecting spontaneous portopulmonary shunts in cirrhotic patients. J Gastroenterol Hepatol 2012; 27:1837-41. [PMID: 22849441 DOI: 10.1111/j.1440-1746.2012.07247.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2012] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Data on prevalence of portopulmonary shunts (PPS) are quite limited. Most studies have used cineportography or echocardiography for diagnosis. Only few recent case reports have reported the use of computed tomography (CT) for identification of PPS. This study tried to determine the prevalence of PPS in patients with cirrhosis using contrast-enhanced CT of the abdomen, and to determine their association with demographic and clinical characteristics. METHODS A total of 150 subjects with cirrhosis who had previously undergone triple-phase CT were analyzed. PPS was diagnosed when at least one esophageal varix met all of the following criteria: (i) it could be followed cephalad into the chest to the level of the inferior pulmonary vein or left atrium; (ii) it abutted the wall of either of these structures; (iii) it had luminal continuity with one of these structures; and (iv) it was no longer seen one slice above the level of contact. RESULTS Of 150 subjects, 18 were excluded for incomplete data. The prevalence of PPS was found to be 26/132 (19.7%). Of these, 14 (53.8%) patients had PPS draining into the left atrium and 12 (46.2%) had those draining into one of the pulmonary veins. Presence of PPS was associated with the presence of varices at endoscopy, ascites, thrombocytopenia and splenomegaly. CONCLUSION In our study, the largest study on PPS to date, the prevalence of PPS in cirrhotic patients using triple phase CT was found to be 19.7%. CT may be a useful technique to study PPS and their clinical implications.
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Affiliation(s)
- German Gonzalez
- Gastroenterology and Hepatology Department, Cleveland Clinic Florida, Weston, Florida 33331, USA
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Computed Tomography Findings of Spontaneous Porto-pulmonary Shunts in 3 Patients With Portal Hypertension. J Thorac Imaging 2010; 25:W70-4. [DOI: 10.1097/rti.0b013e3181a652fa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boonsarngsuk V, Suwatanapongched T. Eosinophilic pleural effusion after gastric variceal obliteration with cyanoacrylate. Respir Med 2007; 101:859-62. [PMID: 17029769 DOI: 10.1016/j.rmed.2006.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Accepted: 08/14/2006] [Indexed: 01/17/2023]
Abstract
Pleuropulmonary complications after endoscopic injection sclerotherapy for treatment of esophagogastric varices are not uncommon but are usually mild and self-limited. Herein we report a male patient with liver cirrhosis who underwent endoscopic injection sclerotherapy, using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil for obliteration of gastric varices. After the procedure, he developed moderate amount of left pleural effusion that persisted for a period of time and required thoracentesis and medical treatment. We believed that the inadvertent retrograde reflux of the embolized glue and ethiodized oil via the portosystemic venous collateral into the left pleura might be the possible mechanism for the development of left pleural effusion as the droplets of ethiodized oil were seen along the left pleura on the imaging studies.
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Affiliation(s)
- Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
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Iga K, Izumi C, Matsumura M, Kitaguchi S, Himura Y, Gen H, Konishi T. Partial pressure of oxygen is lower in the left upper pulmonary vein than in the right in adults with atrial septal defect: difference in P(O2) between the right and left pulmonary veins. Chest 1999; 115:679-83. [PMID: 10084475 DOI: 10.1378/chest.115.3.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The right-to-left shunt at the atrial level is responsible for arterial hypoxemia in patients with atrial septal defect. OBJECTIVES This study investigated the mechanism of arterial hypoxemia in patients with atrial septal defect by measuring the P(O2) in both the right and left upper pulmonary veins. SUBJECTS AND METHOD We prospectively measured the P(O2) in the femoral artery and the right and left upper pulmonary veins during cardiac catheterization in 13 adults (median age, 53 years) and 7 children (median age, 7 years) with secundum atrial septal defect. The adults and children were studied consecutively. Contrast echocardiography was performed to evaluate right-to-left shunt in all adults. RESULTS Among the children, there were no patients showing arterial hypoxemia, and there was no difference in the P(O2) (+/-SD) between the right and left upper pulmonary veins (right, 100+/-3.8 mm Hg vs left, 100+/-7.8 mm Hg; p = 0.92). However, arterial hypoxemia was present in 11 of the 13 adult patients, although contrast echocardiography showed more than a moderate degree of right-to-left shunt in only four adults. The P(O2) was lower in the left upper pulmonary vein than it was in the right upper pulmonary vein in all adult patients (right, 91.6+/-13.8 mm Hg vs left, 73.0+/-11.5 mm Hg; p < 0.0001). CONCLUSION The P(O2) was lower in the left upper pulmonary vein than it was in the right upper pulmonary vein in adults with atrial septal defect. Care must be taken in measuring pulmonary blood flow if the P(O2) in the left upper pulmonary vein is low enough to influence oxygen content. The decreased P(O2) in the left upper pulmonary vein may contribute to arterial hypoxemia in addition to right-to-left shunt at the atrial level in adults with atrial septal defect.
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Affiliation(s)
- K Iga
- Department of Cardiology, Tenri Hospital, Japan.
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MURAKAMI M, HOSHIKA A, YANO H, ARAKI K, YANO T, OHSHIMA K, KOKUBU S. Hematoma with High Oxygen Partial Pressure Resulting from Injection Sclerotherapy for Esophageal Varices — Report of a Case. Dig Endosc 1999. [DOI: 10.1111/j.1443-1661.1999.tb00193.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
| | - Akiko HOSHIKA
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Harumi YANO
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Katsuyuki ARAKI
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Tetsuro YANO
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Kanji OHSHIMA
- *Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Shigehiro KOKUBU
- **Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa, Japan
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Abstract
Pulmonary hypertension develops in approximately 2% of patients with portal hypertension. Diagnosis is often difficult and requires a high degree of clinical suspicion. Treatment of patients with portal and pulmonary hypertension is limited, and mean survival following diagnosis is approximately 15 months. The effect of liver transplantation on the natural history of disease is discussed.
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Affiliation(s)
- M S Mandell
- Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, USA
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Shimoji K, Itoh S, Kameda C, Shiomi M. 99mTc-DTPA activity in the azygos vein before and after sclerotherapy in patients with cirrhosis. Eur J Radiol 1993; 17:106-12. [PMID: 8223676 DOI: 10.1016/0720-048x(93)90044-n] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We determined the radioactivity of 99mTc-diethylene-triamine pentaacetic acid (99mTc-DTPA) from the azygos vein in 20 patients with cirrhosis to evaluate the hemodynamic relationship between esophageal varices and azygos venous blood flow before and after sclerotherapy. 99mTc-DTPA was injected into the splenic artery before and after sclerotherapy through a catheter in the right femoral artery. The patients were classified into three types. Type I consisted of nine patients who showed maximum levels of 99mTc-DTPA which were significantly lower (P < 0.01) than those determined before sclerotherapy. The Type II was composed of six patients who had far lower radioactivity levels than those of Type I, but also showed significantly lower maximum activity after sclerotherapy than before (P < 0.01). The five patients in Type III had significantly higher radioactivity after sclerotherapy than before (P < 0.05). Rupture of the esophageal varices occurred in one of the Type I (11.1%), none of the Type II, and four of Type III (80%) cases, among all of the patients followed for 40 months after sclerotherapy. The radioactivity in the azygos vein appeared later in Type I (P < 0.05) and Type II after sclerotherapy than before sclerotherapy, but in Type III there was no difference between pre- and post-sclerotherapy values. Type III patients in whom portography was performed showed short gastric and paraesophageal veins, whereas Type I and Type II patients did not. These data suggest that radioactivity in the azygos vein before and after sclerotherapy reflect the grade of shunting and estimate the recurrence of bleeding in patients with cirrhosis associated with esophageal varices.
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Affiliation(s)
- K Shimoji
- Third Department of Internal Medicine, Saitama Medical School, Japan
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Abstract
Despite a wide array of mechanisms implicated in esophagogastric varix hemorrhage, predicting the onset of bleeding or even identifying the dominant factor in its causation has proved elusive. In this article we re-examine variceal pathophysiology and hypothesize that bleeding is rooted in turbulent portal system flow, a phenomenon embodied in the 'new' science of chaos and the principles of non-linear, rhythmic fluid dynamics. Analogous to forecasting the weather, predicting turbulent flow hinges on defining the initial physical conditions, and, like the field theory of quantum physics, depends on probabilities and instabilities rather than direct proportional analysis. Based on the complex regional and systemic hemodynamic forces and local physical properties underlying formation and perpetuation of esophagogastric varices, we propose, as with climatologic events, that a relatively minor or remote physiologic adjustment may set into motion a sequence of destabilizing splanchnic blood flow kinetics that ultimately causes a varix to erupt. In other words, the onset of varix bleeding derives from a sudden, erratic switch from disorganized but stable to disruptive turbulent variceal blood flow, and as a 'chaotic' phenomenon, is likely to remain for the foreseeable future highly unpredictable.
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Affiliation(s)
- C L Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson 85724
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15
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Oh KS, Newman B, Bender TM, Bowen A. Pulmonary Pseudofibrosis and Pseudomass Lesions. Radiol Clin North Am 1988. [DOI: 10.1016/s0033-8389(22)00991-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
A vast spectrum of pulmonary pathologic conditions occurs in association with chronic liver diseases, and clinically important manifestations, such as arterial hypoxemia, can result. Both pulmonary vascular and parenchymal abnormalities can contribute to the dysfunction, as evidenced by results of pulmonary function tests and gas exchange studies. The clinical implications of identifying such pulmonary problems range from alleviation of symptoms, especially dyspnea, to comprehensive assessment of patients before and after liver transplantation. Physicians should be aware of these potential pulmonary disorders that can complicate liver disease and liver transplantation so that management of affected patients can be improved.
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Moriyasu F, Ban N, Nishida O, Nakamura T, Koizumi S, Sakai M, Kanematsu Y, Miyake T, Uchino H. Quantitative measurement of portal blood flow in patients with chronic liver disease using an ultrasonic Duplex system consisting of a pulsed Doppler flowmeter and B-mode electroscanner. GASTROENTEROLOGIA JAPONICA 1984; 19:529-36. [PMID: 6098510 DOI: 10.1007/bf02793866] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Portal blood flow (PBF) can be measured quantitatively using a B-mode combined pulsed Doppler (BCD) system. This system combines a real time B-mode linear type electroscanner and a pulsed Doppler (D-mode) flowmeter. Since both modes are displayed in realtime, Doppler blood flow signals can be retrieved at will from any depth. The blood flow velocity determined by the Doppler spectrogram and the vascular cross-sectional area measured from the B-mode tomographic image enables the quantitative calculation of blood flow volume. Using this system, PBF was measured quantitatively in 88 healthy adults, 54 patients with chronic hepatitis, 65 with cirrhosis of the liver, 27 with primary hepatoma and 12 with idiopathic portal hypertension (IPH). Results of PBF volume measurement were as follows: 889 +/- 284 ml/min (mean +/- S.D.) for healthy adults, 851 +/- 237 ml/min for patients with chronic hepatitis, 870 +/- 289 ml/min for cirrhosis of the liver, 966 +/- 375 ml/min for primary hepatoma and 1,047 +/- 381 ml/min for IPH. These preliminary results demonstrated that this ultrasonic Duplex system is clinically useful to determine the quantitative amount of PBF.
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Oh KS, Bender TM, Bowen A, Ledesma-Medina J. Plain radiographic, nuclear medicine and angiographic observations of hepatogenic pulmonary angiodysplasia. Pediatr Radiol 1983; 13:111-5. [PMID: 6223268 DOI: 10.1007/bf01624390] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Clinical and radiological findings of hepatogenic pulmonary angiodysplasia are reported in two cases. Myriad spidery pulmonary blood vessels are seen on plain radiographs and verified with right to left intrapulmonary shunting on pulmonary angiogram and pulmonary isotopic perfusion scan. Pathophysiology and differential diagnosis are discussed. We propose that the term "pulmonary angio-dysplasia" should include: 1) Pulmonary telangiectasia 2) Hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber syndrome) 3) Classical discrete pulmonary arteriovenous fistula 4) Hepatogenic pulmonary angiodysplasia: pulmonary arteriovenous communications with right to left shunting secondary to hepatic cirrhosis.
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