Author/Authors :
Wang, Ji-Chen Department of Ultrasound - Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China , Cai, Shi-Feng Department of Radiology - Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China , Su, Chen Department of Ultrasound - Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China , Fan, Hui-Li Department of Ultrasound - Heze Municipal Hospital of Shandong Province, Heze, China , Gai, Yong-Hao Department of Ultrasound - Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China , Wang, Guang-Chuan Department of Gastroenterology - Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China , Chen, Li Department of Ultrasound - Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
Abstract :
Background: Spontaneous portosystemic shunts (SPSS) are one of the hallmarks of Budd-Chiari syndrome (BCS). Ultrasound can
accurately show the location and type of portosystemic collaterals.
Objectives: To study the sonographic feature of SPSS in patients with BCS and to evaluate differences in the main portal vein diameter among multiple types of portosystemic shunts.
Patients and Methods: Ultrasonographies of 44 patients with SPSS among 352 BCS patients between June 2000 and November
2015 were reviewed retrospectively. The SPSS in 44 BCS patients were first detected by ultrasound and then confirmed via digital
subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance venography (MRV). The location,
course, diameter and hemodynamics of the spontaneous portosystemic shunts were observed by ultrasound. In addition, one-way
analysis of variance (ANOVA) was performed to evaluate the difference in the main portal vein diameter between the different shunt
types.
Results: The blood drainage patterns of SPSS in 44 of 352 patients with BCS were classified as the following five types: portalumbilical shunts (15/44), portal-hepatic shunts (11/44), portal-accessory hepatic shunts (6/44) (the accessory hepatic veins included
the inferior right hepatic vein and the caudate lobe vein), splenorenal shunts (8/44) and main portal vein-inferior vena cava shunts
(4/44). The corresponding hemodynamics of the five types mentioned above were obtained. Main portal vein-inferior vena cava
shunts had a significantly larger mean portal trunk diameter compared with all other types (P < 0.05 for all comparisons). In addition, the mean portal trunk diameters in portal-umbilical shunts and portal-hepatic shunts were obviously larger than that of
splenorenal shunts (P < 0.05), while there were no statistically significant differences between the other types.
Conclusion: Spontaneous portosystemic shunts are not rare in patients with BCS. Ultrasound is a reliable means for their diagnosis
and it offers substantial information for use in clinical treatment.
