Open AccessImaging and radiological interventions in extra-hepatic portal vein obstruction
Author(s) -
Sudheer Pargewar,
Saloni N. Desai,
S Rajesh,
Vaibhav Singh,
Ankur Arora,
Amar Mukund
Publication year - 2016
Publication title -
world journal of radiology
Language(s) - English
Resource type - Journals
ISSN - 1949-8470
DOI - 10.4329/wjr.v8.i6.556
Subject(s) - medicine , radiology , portal hypertension , transjugular intrahepatic portosystemic shunt , percutaneous , portal vein thrombosis , budd–chiari syndrome , percutaneous transhepatic cholangiography , cholangiography , magnetic resonance imaging , embolization , portosystemic shunt , portal venous pressure , balloon dilation , balloon , surgery , inferior vena cava , portal vein , cirrhosis
Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS.