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Kim JH, Kim S, Nam HC, Kim CW, Yoo JS, Han JW, Jang JW, Choi JY, Yoon SK, Chun HJ, Lee SE, Oh JS, Sung PS. Role of Portosystemic Shunt and Portal Vein Stent in Managing Portal Hypertension Due to Hematological Diseases. Cureus 2024; 16:e54206. [PMID: 38496121 PMCID: PMC10942847 DOI: 10.7759/cureus.54206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Patients with hematological diseases experience complications related to portal hypertension, including life-threatening complications such as variceal bleeding. METHODS We analyzed the prognosis of patients with hematological diseases and portal hypertension treated with transjugular intrahepatic portosystemic shunts (TIPS) or portal vein stents. We retrospectively assessed patients with hematological diseases and portal hypertension who had variceal bleeding. We evaluated the characteristics and prognosis of the enrolled patients. A total of 11 patients with hematological diseases who underwent TIPS, or portal vein stenting, were evaluated. RESULTS The median follow-up period was 420 days. Of the 11 patients, eight showed resolution of portal hypertension and its complications following TIPS, or stent insertion. One patient experienced rebleeding due to incomplete resolution of portal hypertension, and two other patients also experienced rebleeding because they underwent TIPS closure or revision due to repetitive hepatic encephalopathy. CONCLUSION Portosystemic shunt and stent installation are effective treatment options for portal hypertension due to hematological diseases.
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Affiliation(s)
- Ji Hoon Kim
- Gastroenterology and Hepatology, Uijeongbu St. Mary's Hospital, Uijeongbu, KOR
| | - Suho Kim
- Radiology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Hee-Chul Nam
- Gastroenterology and Hepatology, Uijeongbu St. Mary's Hospital, Uijeongbu, KOR
| | - Chang Wook Kim
- The Catholic University of Korea, Internal Medicine, Uijeongbu, KOR
| | - Jae-Sung Yoo
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Ji Won Han
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Jeong Won Jang
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Jong Young Choi
- Gastroenterology and Hepatology, Seoul St. mary's Hospital, Seoul, KOR
| | - Seung Kew Yoon
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Ho-Jong Chun
- Radiology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Sung-Eun Lee
- Hematology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Jung-Suk Oh
- Radiology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Pil Soo Sung
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
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Abdoh Q, Alnees M, Rajab I, Zayed A, Salim H, Barqawi A, Amer R. Splenic infarction secondary to polycythemia Vera: Case report and literature review. Radiol Case Rep 2023; 18:3636-3641. [PMID: 37593336 PMCID: PMC10432139 DOI: 10.1016/j.radcr.2023.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
Splenic infarction is a medical condition characterized by compromised blood flow to the spleen, resulting in partial or complete organ infarction. This condition is commonly observed in patients with an increased risk of thrombosis, such as those with Polycythemia Vera (PV). A 40-year-old female patient presented with fatigue, weakness, and an enlarged spleen, further tests revealed elevated levels of hemoglobin, white blood cells, and platelets. A bone marrow biopsy and positive Jack II mutations confirmed the diagnosis of PV. The patient later developed portal hypertension, varices, and splenic infarction. This case report aims to raise awareness about the potential complications of PV and emphasizes the importance of early intervention to prevent serious consequences such as splenic infarction. Additionally, it highlights the role of splenectomy in managing complications associated with PV.
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Affiliation(s)
- Qusay Abdoh
- Department of Medicine, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
- Department of Internal Medicine, GI and Endoscopy unit, An-Najah National University Hospital, Nablus, Palestine
| | - Mohammad Alnees
- Department of Medicine, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Islam Rajab
- Department of Medicine, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Alaa Zayed
- Department of Medicine, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hamza Salim
- Department of Medicine, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdelkarim Barqawi
- Department of Medicine, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
| | - Riad Amer
- Department of Medicine, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
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3
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Gemnani RR, Parepalli A, Kumar S, Acharya S, Shukla S. Chronic Myeloid Leukemia Presenting as Non-cirrhotic Portal Hypertension. Cureus 2023; 15:e40692. [PMID: 37485152 PMCID: PMC10358785 DOI: 10.7759/cureus.40692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Non-cirrhotic portal hypertension (NCPH) is a poorly understood condition attributed to various causes in the absence of liver cirrhosis. One of the important and rare conditions leading to NCPH is myeloproliferative neoplasms and blood coagulation abnormalities, which infiltrate the liver cells leading to stasis and raised sinusoidal pressure. We present a rare case of a 40-year-old male who presented to our emergency department with complaints of hematemesis and Malena and was later diagnosed with NCPH associated with chronic myeloid leukemia (CML). This case report emphasizes the importance of considering rare causes of NCPH like CML while evaluating such cases.
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Affiliation(s)
- Rinkle R Gemnani
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Avinash Parepalli
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Wardha, IND
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Davidson M, Wong F, Atri M, Sibai H, Maze D, Cheung V, Callum J, Atenafu EG, Gupta V. Screening for signs of portal hypertension by esophagogastroduodenoscopy in patients with BCR-ABL negative myeloproliferative neoplasms. Am J Hematol 2023; 98:E88-E90. [PMID: 36691792 DOI: 10.1002/ajh.26861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Affiliation(s)
- Marta Davidson
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Florence Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Mostafa Atri
- Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Hassan Sibai
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Dawn Maze
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Verna Cheung
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Vikas Gupta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Sahin NE, Oner Z, Oner S, Turan MK. A study on the correlation between spleen volume estimated via cavalieri principle on computed tomography images with basic hemogram and biochemical blood parameters. Anat Cell Biol 2022; 55:40-47. [PMID: 35000931 PMCID: PMC8968228 DOI: 10.5115/acb.21.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/22/2021] [Accepted: 11/20/2021] [Indexed: 11/27/2022] Open
Abstract
Considering its hematological and immunological functions, spleen is a very important organ. A change occurs in its size as the spleen performs these functions. This study aims to examine the possible relationships between spleen volume and the basic hemogram and biochemical parameters in serum. Multidetector computed tomography images and basic hemogram and biochemical parameters of 74 adult individuals, 34 male and 40 female, who were found to be healthy, were used in the study. Spleen volume was estimated using the Cavalieri method on multidetector computed tomography images and the correlations between the volume value with basic hemogram and biochemistry parameters were researched. While negative significant correlations were found between the estimated spleen volume and lymphocyte percentage (r=–0.224) and platelet level (r=–0.271); positive significant correlations were found between hemoglobin level (r=0.228), hematocrit level (r=0.237), alanine aminotransferase (r=0.345), and erythrocyte level (r=0.375). As a result of this study, a relationship was found between spleen volume and lymphocyte percentage, hematocrit level, erythrocyte level, platelet level, and alanine aminotransferase level in serum. We believe that the results of the study will provide a larger perspective to clinicians in the diagnosis of diseases associated with spleen.
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Affiliation(s)
- Necati Emre Sahin
- Department of Anatomy, Faculty of Medicine, Karabük University, Karabük, Turkey
| | - Zulal Oner
- Department of Anatomy, Faculty of Medicine, İzmir Bakırçay University, İzmir, Turkey
| | - Serkan Oner
- Department of Radiology, Faculty of Medicine, İzmir Bakırçay University, İzmir, Turkey
| | - Muhammed Kamil Turan
- Department of Medical Biology, Faculty of Medicine, Karabük University, Karabük, Turkey
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Giszas B, Weber M, Heidel FH, Reuken PA. Recurrent Upper Gastrointestinal Bleeding from Isolated Gastric Varices as Primary Symptom of Myelofibrosis: A Case Report on Combining Interventional and Pharmacologic Treatment Options. Dig Dis 2021; 40:530-534. [PMID: 34348280 DOI: 10.1159/000518766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/28/2021] [Indexed: 02/02/2023]
Abstract
Portal hypertension leads to pronounced venous collateralization and development of varices. Besides manifest liver cirrhosis, primarily left-sided portal hypertension is causal for the development of gastric varices. We present a case of a 36-year-old female patient with splenomegaly, underlying primary myelofibrosis, and detection of somatic Janus-kinase-2 driver-mutation JAK2V617F. Following first upper gastrointestinal bleeding, isolated gastric varices could be detected as a result of underlying left-sided portal hypertension. Within a few months, repeated life-threatening bleedings with transfusion requirements and frequent hospitalizations occurred. Despite multiple injections of cyanoacrylates, the proven therapy of choice, varices could not be stabilized. Combination of targeted JAK-inhibitor therapy in conjunction with the use of EUS-guided application of coils with subsequent cyanoacrylate injection resulted in acute and long-term bleeding control.
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Affiliation(s)
- Benjamin Giszas
- Department of Internal Medicine IV - Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Jena, Germany
| | - Marko Weber
- Department of Internal Medicine IV - Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Jena, Germany
| | - Florian H Heidel
- Department of Internal Medicine II - Haematology and Oncology, Jena University Hospital, Jena, Germany.,Internal Medicine C, Haematology, Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Greifswald, Germany
| | - Philipp A Reuken
- Department of Internal Medicine IV - Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Jena, Germany
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Law NL, Villada FA, Kruse MJ. Rupture of splenic artery aneurysm in a man with polycythemia vera and acquired von Willebrand syndrome. BMJ Case Rep 2021; 14:14/6/e243316. [PMID: 34167989 DOI: 10.1136/bcr-2021-243316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Nathan L Law
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Fabio A Villada
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Matthew J Kruse
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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Al-Qadi M, LeVarge B, Ford HJ. Epidemiology, Pathogenesis, and Clinical Approach in Group 5 Pulmonary Hypertension. Front Med (Lausanne) 2021; 7:616720. [PMID: 33842491 PMCID: PMC8026868 DOI: 10.3389/fmed.2020.616720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023] Open
Abstract
Pulmonary hypertension (PH) is recognized to be associated with a number of comorbid conditions. Based on these associations, PH is classified into 5 groups, considering common pathophysiologic drivers of disease, histopathologic features, clinical manifestations and course, and response to PH therapy. However, in some of these associated conditions, these characteristics are less well-understood. These include, among others, conditions commonly encountered in clinical practice such as sarcoidosis, sickle cell disease, myeloproliferative disorders, and chronic kidney disease/end stage renal disease. PH in these contexts presents a significant challenge to clinicians with respect to disease management. The most recent updated clinical classification schemata from the 6th World Symposium on PH classifies such entities in Group 5, highlighting the often unclear and/or multifactorial nature of PH. An in-depth review of the state of the science of Group 5 PH with respect to epidemiology, pathogenesis, and management is provided. Where applicable, future directions with respect to research needed to enhance understanding of the clinical course of these entities is also discussed.
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Affiliation(s)
- Mazen Al-Qadi
- Division of Pulmonary and Critical Care Medicine, Pulmonary Hypertension Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Barbara LeVarge
- Division of Pulmonary and Critical Care Medicine, Pulmonary Hypertension Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - H James Ford
- Division of Pulmonary and Critical Care Medicine, Pulmonary Hypertension Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Myelofibrosis and Portal Hypertension: The Case for Primary Variceal Screening. ACG Case Rep J 2020; 7:e00333. [PMID: 32440527 PMCID: PMC7209799 DOI: 10.14309/crj.0000000000000333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/19/2019] [Indexed: 11/23/2022] Open
Abstract
Myelofibrosis is a hematologic condition that predisposes to the formation of large and small portal venous clots. Portal injury is believed to underlie the mechanism of development of noncirrhotic portal hypertension in this population. We describe a patient with myelofibrosis, proven portal hypertension, and extramedullary hematopoiesis with no imaging or pathologic evidence of microvascular or macrovascular portal clot. We provide a concise review of the literature which highlights that patients with myelofibrosis and related conditions of polycythemia vera and essential thrombocytosis present not infrequently with portal hypertension and variceal bleeding. We propose this population may benefit from primary variceal screening.
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Wei XQ, Zheng ZH, Jin Y, Tao J, Abassa KK, Wen ZF, Shao CK, Wei HB, Wu B. Intestinal obstruction caused by extramedullary hematopoiesis and ascites in primary myelofibrosis. World J Gastroenterol 2014; 20:11921-11926. [PMID: 25206301 PMCID: PMC4155387 DOI: 10.3748/wjg.v20.i33.11921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/18/2014] [Accepted: 05/26/2014] [Indexed: 02/07/2023] Open
Abstract
Primary myelofibrosis (PMF) is a clonal hematopoietic stem cell disorder. It is characterized by bone marrow fibrosis, extramedullary hematopoiesis with hepatosplenomegaly and leukoerythroblastosis in the peripheral blood. The main clinical manifestations of PMF are anemia, bleeding, hepatosplenomegaly, fatigue, and fever. Here we report a rare case of PMF with anemia, small bowel obstruction and ascites due to extramedullary hematopoiesis and portal hypertension. The diagnosis was difficult to establish before surgery and the differential diagnosis is discussed.
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