Venous Thrombosis and Occlusion After Pancreas Transplantation
Evaluation with Breath-Hold Gadolinium-Enhanced Three-Dimensional MR Imaging
William B. Eubank1,2,
Udo P. Schmiedl1,
Adam E. Levy3 and
Christopher L. Marsh3
1
Department of Radiology, University of Washington School of Medicine, 1959
N.E. Pacific St., Seattle, WA 98195-7115.
2
Department of Radiology (114), Veterans Affairs Medical Center, 1660 S.
Columbian Way, Seattle, WA 98108-1597.
3
Department of Surgery, University of Washington School of Medicine, Seattle,
WA 98195-7115.
View larger version (35K):
[in a new window]
|
Fig. 1A. —Normal vascular anatomy of transplanted pancreas. Drawing shows
vascular anastomoses to transplanted pancreas. Y graft (YG) made from the
donor common iliac bifurcation is anastomosed end-to-side to recipient common
iliac artery. Donor splenic artery (SA) and superior mesenteric artery (SMA)
are anastomosed to two limbs of Y graft. Donor portal vein (PV) is anastomosed
end-to-side to recipient common iliac vein and drains splenic vein (SV) and
superior mesenteric vein (SMV). Exocrine secretions are drained through
duodenocystostomy (DC). Note recipient's abdominal aorta (Ao) and inferior
vena cava (IVC).
|
|
View larger version (92K):
[in a new window]
|
Fig. 1B. —Normal vascular anatomy of transplanted pancreas. Shaded-surface
display three-dimensional reconstruction from multiphasic breath-hold
gadolinium-enhanced MR image of 47-year-old male recipient shows both Y graft
arterial anatomosis (straight arrow) and portal venous anastomosis
(curved arrow) to common iliac artery and common iliac vein,
respectively.
|
|
View larger version (141K):
[in a new window]
|
Fig. 2A. —29-year-old woman who developed clinical signs of pancreatitis and
pancreatic graft dysfunction 2 months after simultaneous
renal—pancreatic transplantation. Venous thrombosis was confirmed by
serial color Doppler sonography. Coronal source image from venous phase of
breath-hold gadolinium-enhanced three-dimensional MR examination shows
nonopacified veins (arrows) in head of transplanted pancreas in right
lower quadrant.
|
|
View larger version (134K):
[in a new window]
|
Fig. 2B. —29-year-old woman who developed clinical signs of pancreatitis and
pancreatic graft dysfunction 2 months after simultaneous
renal—pancreatic transplantation. Venous thrombosis was confirmed by
serial color Doppler sonography. Axial T2-weighted fast spin-echo MR image
shows peripancreatic fluid surrounding anterior surface of pancreatic graft
(arrows). Note ill-defined areas of increased signal intensity
involving graft parenchyma.
|
|
View larger version (86K):
[in a new window]
|
Fig. 3A. —48-year-old man with early (first 2 weeks after transplantation)
graft dysfunction who eventually required pancreatectomy for parenchymal
necrosis. Initial Doppler sonogram obtained 4 days after transplantation shows
high-resistive arterial flow within graft parenchyma and lack of parenchymal
venous flow. Patient was subsequently anticoagulated for presumed venous
thrombosis of pancreatic graft.
|
|
View larger version (169K):
[in a new window]
|
Fig. 3B. —48-year-old man with early (first 2 weeks after transplantation)
graft dysfunction who eventually required pancreatectomy for parenchymal
necrosis. Coronal source image from venous phase of breath-hold
gadolinium-enhanced three-dimensional (3D) MR examination obtained 10 days
after transplantation shows nonopacification of splenic vein
(arrow).
|
|
View larger version (154K):
[in a new window]
|
Fig. 3C. —48-year-old man with early (first 2 weeks after transplantation)
graft dysfunction who eventually required pancreatectomy for parenchymal
necrosis. Coronal maximum-intensity-projection image from venous phase of same
imaging as B shows narrowing of venous anastomosis
(arrow).
|
|
View larger version (142K):
[in a new window]
|
Fig. 3D. —48-year-old man with early (first 2 weeks after transplantation)
graft dysfunction who eventually required pancreatectomy for parenchymal
necrosis. Coronal source image from arterial phase of breath-hold
gadolinium-enhanced 3D MR examination obtained 1 month after transplantation
shows heterogeneous enhancement of parenchyma in head of transplanted pancreas
(arrows).
|
|
View larger version (171K):
[in a new window]
|
Fig. 4A. —43-year-old man with onset of abdominal pain, worsening
hyperglycemia, and decreasing levels of urinary amylase beginning 3 weeks
after resection of previously failed pancreatic graft and placement of new
pancreatic graft. Subvolume coronal maximum-intensity-projection image from
venous phase of breath-hold gadolinium-enhanced three-dimensional MR image
shows nonopacification of portal venous anastomosis (arrow). Note
opacified arterial anastomosis (arrowhead) and homogeneous
enhancement of graft parenchyma.
|
|
View larger version (125K):
[in a new window]
|
Fig. 4B. —43-year-old man with onset of abdominal pain, worsening
hyperglycemia, and decreasing levels of urinary amylase beginning 3 weeks
after resection of previously failed pancreatic graft and placement of new
pancreatic graft. Conventional venogram of inferior vena cava and common iliac
veins confirms occlusion of portal venous anastomosis of pancreas transplant
located in right lower quadrant. Note reflux of contrast material into patent
vein of transplanted kidney in left lower quadrant (arrow). Patient
was successfully treated with intraarterial infusion of tissue plasminogen
activator, angioplasty, and systemic anticoagulation.
|
|
View larger version (123K):
[in a new window]
|
Fig. 5A. —37-year-old man who developed severe lower abdominal pain, increase
in serum amylase level and insulin requirement, and decrease in urinary
amylase level within first week after kidney—pancreas transplantation.
pancreatectomy revealed complete torsion of donor portal vein near anastomosis
and parenchymal necrosis involving entire graft. Coronal source image from
unenhanced breath-hold three-dimensional (3D) MR examination obtained on sixth
day after transplantation shows pancreas transplant in right lower quadrant
(between straight arrows) and renal transplant in left lower quadrant
(curved arrow).
|
|
View larger version (127K):
[in a new window]
|
Fig. 5B. —37-year-old man who developed severe lower abdominal pain, increase
in serum amylase level and insulin requirement, and decrease in urinary
amylase level within first week after kidney—pancreas transplantation.
Pancreatectomy revealed complete torsion of donor portal vein near anastomosis
and parenchymal necrosis involving entire graft. Coronal source image from
arterial phase of breath-hold 3D MR examination shows complete lack of
parenchymal enhancement of pancreas transplant and corticomedullary phase
enhancement of kidney transplant.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2000 by the American Roentgen Ray Society.
