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Detection of cavernous transformation of the portal vein by contrast-enhanced ultrasound

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Abstract

Purpose

Cavernous transformation of the portal vein can be missed on color Doppler exam or arterial phase cross-sectional imaging due to their slow flow and delayed enhancement. Contrast-enhanced ultrasound (CEUS) offers many advantages over other imaging techniques and can be used to successfully detect cavernous transformations of the portal vein.

Methods

A 10-month-old female was followed for repeat episodes of hematemesis. Computed tomography angiography (CTA) and magnetic resonance arteriogram (MRA) and portal venography were performed. Color Doppler exam of the portal vein was performed followed by administration of Lumason, a microbubble US contrast agent.

Results

Magnetic resonance arteriogram, CTA, and color Doppler exam at the time of initial presentation was unremarkable without obvious vascular malformation within the limits of motion degraded exam. At 8-month follow-up, esophagogastroduodenoscopy revealed a vascular malformation in the distal esophagus which was sclerosed. At 6 month after sclerosis of the lesion, portal venography revealed occlusion of the portal vein with extensive collateralization. Color Doppler revealed subtle hyperarterialization and periportal collaterals. CEUS following color Doppler exam demonstrated extensive enhancement of periportal collaterals. Repeat color Doppler after contrast administration demonstrated extensive Doppler signal in the collateral vessels, suggestive of cavernous transformation.

Conclusions

We describe a case of cavernous transformation of the portal vein missed on initial color Doppler, CTA and MRA, but detected with contrast-enhanced ultrasound technique.

Sommario

Scopo

La trasformazione cavernomatosa della vena porta può sfuggire all’esame color Doppler o nell’arterial phase cross sectional imaging a causa del flusso lento e al ritardato enhancement. L’ecografia con mezzo di contrasto (CEUS) offre molti vantaggi rispetto ad altre tecniche di imaging e può essere utilizzata per rilevare con successo i cavernomi della vena porta.

Metodi

Una bimba di 10 mesi è stata seguita per ripetuti episodi di ematemesi. Sono state eseguite angiografia con tomografia computerizzata (CTA) e angiografia con Risonanza Magnetica (MRA) e flebografia portale. È stato eseguito l’esame color Doppler della vena porta, seguito dalla somministrazione di Lumason, un agente di contrasto ecografico con microbolle.

Risultati

L’esame MRA, CTA e color Doppler al momento della presentazione iniziale era negativo senza evidenti malformazioni vascolari con i limiti della degradazione delle immagini di movimento. A 8 mesi di follow-up, l’esofagogastroduodenoscopia (EGD) ha rivelato una malformazione vascolare nell’esofago distale che veniva sclerosata. A 6 mesi dopo la sclerosi della lesione, la venografia portale ha rivelato l’occlusione della vena porta con circoli collaterali. Il color Doppler ha rivelato sottile iperarterializzazione e vasi collaterali periportali. L’esame color Doppler successivo alla CEUS ha dimostrato un ampio miglioramento dei circoli collaterali periportali. Ripetuto il color Doppler dopo la somministrazione di contrasto ha dimostrato un ampio segnale Doppler nei vasi collaterali, indicativo di trasformazione cavernosa.

Conclusioni

Descriviamo un caso di trasformazione cavernomatosa della vena porta mancata inizialmente dal color Doppler, CTA e MRA, ma rilevata con l’ecografia con mezzo di contrasto.

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Acknowledgements

None.

Author information

Correspondence to Misun Hwang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of retrospective case report, formal consent is not required.

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Hwang, M., Thimm, M.A. & Guerrerio, A.L. Detection of cavernous transformation of the portal vein by contrast-enhanced ultrasound. J Ultrasound 21, 153–157 (2018) doi:10.1007/s40477-018-0288-3

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Keywords

  • Contrast-enhanced ultrasound (CEUS)
  • Cavernous transformation
  • Portal vein