Three-Dimensional Portography Using Multislice Helical CT Is Clinically Useful for Management of Gastric Fundic Varices
Akiko Matsumoto1,
Mikiya Kitamoto1,
Michio Imamura1,
Toshio Nakanishi1,
Chiaki Ono2,
Katsuhide Ito2 and
Goro Kajiyama1
1
First Department of Internal Medicine, Hiroshima University School of
Medicine, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
2
Department of Radiology, Hiroshima University School of Medicine, Hiroshima
734-8551, Japan.
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Fig. 1A. —74-year-old man with Child classification A hepatitis C
virus-related liver cirrhosis and gastric fundic varices (form 3).
Three-dimensional CT portogram reveals left gastric vein (black
arrowhead), posterior gastric vein (small arrow), gastric fundic
varices (large arrow), and gastrorenal shunt (white
arrowhead).
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Fig. 1B. —74-year-old man with Child classification A hepatitis C
virus-related liver cirrhosis and gastric fundic varices (form 3).
Conventional angiographic portogram reveals left gastric vein
(arrowhead), gastric fundic varices (large arrow), and
gastrorenal shunt (small arrow) similar to those seen in
A.
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Fig. 2A. —62-year-old man with Child classification B hepatitis C
virus-related liver cirrhosis and gastric fundic varices (form 3).
Three-dimensional CT portogram reveals left gastric vein (white
arrowhead), posterior gastric vein (small arrow), gastric fundic
varices (large arrow), and gastrorenal shunt (black
arrowhead).
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Fig. 2B. —62-year-old man with Child classification B hepatitis C
virus-related liver cirrhosis and gastric fundic varices (form 3).
Conventional angiographic portogram reveals left gastric vein
(arrowhead), gastric fundic varices (black arrow), and
gastrorenal shunt (white arrow) similar to those seen in
A.
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Fig. 3A. —77-year-old woman with Child classification B hepatitis C
virus-related liver cirrhosis and gastric fundic varices (form 3).
Three-dimensional CT portogram clearly depicts small left gastric vein
(arrowhead).
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Fig. 3B. —77-year-old woman with Child classification B hepatitis C
virus-related liver cirrhosis and gastric fundic varices (form 3).
Conventional angiographic portogram reveals left gastric vein
(arrowhead).
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Fig. 4A. —77-year-old woman with Child classification B hepatitis C
virus-related liver cirrhosis and gastric fundic varices (form 3).
Three-dimensional CT portogram delineates inferior phrenic vein
(arrowhead) and pericardiophrenic vein (arrow) as outflowing
vessels.
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Fig. 4B. —77-year-old woman with Child classification B hepatitis C
virus-related liver cirrhosis and gastric fundic varices (form 3).
Conventional angiographic portogram reveals inferior phrenic vein
(arrowhead) seen in A.
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Fig. 5A. —52-year-old woman with Child classification A hepatitis B
virus-related liver cirrhosis and gastric fundic varices (form 3). Gastric
varices were successfully treated with balloon-occluded retrograde transvenous
obliteration. Three-dimensional (3D) image CT portogram before treatment shows
images of entire portosystemic collaterals, including gastric fundic varices
(arrow) and gastrorenal shunt (arrowhead).
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Fig. 5B. —52-year-old woman with Child classification A hepatitis B
virus-related liver cirrhosis and gastric fundic varices (form 3). Gastric
varices were successfully treated with balloon-occluded retrograde transvenous
obliteration. Endoscopic image before treatment reveals huge gastric fundic
varices (arrowheads).
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Fig. 5C. —52-year-old woman with Child classification A hepatitis B
virus-related liver cirrhosis and gastric fundic varices (form 3). Gastric
varices were successfully treated with balloon-occluded retrograde transvenous
obliteration. Retrograde venogram obtained during balloon occlusion reveals
inferior phrenic vein (arrow), but gastric varices are not
visible.
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Fig. 5D. —52-year-old woman with Child classification A hepatitis B
virus-related liver cirrhosis and gastric fundic varices (form 3). Gastric
varices were successfully treated with balloon-occluded retrograde transvenous
obliteration. Venogram shows balloon-occluded retrograde transvenous
obliteration. Gastric fundic varices were completely obliterated by 5%
ethanolamine oleate iopamidol injected in retrograde manner during balloon
occlusion. After insertion of embolic coils into inferior phrenic vein
(small arrow), gastric varices that corresponded to 3D images
(large arrow) were delineated by 5% ethanolamine oleate iopamidol.
Subsequently, posterior gastric vein (arrowhead) was retrogradely
opacified.
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Fig. 5E. —52-year-old woman with Child classification A hepatitis B
virus-related liver cirrhosis and gastric fundic varices (form 3). Gastric
varices were successfully treated with balloon-occluded retrograde transvenous
obliteration. Three-dimensional CT portogram obtained 1 week after retrograde
transvenous obliteration reveals disappearance of gastric varices, gastrorenal
shunt, and posterior gastric vein.
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Fig. 5F. —52-year-old woman with Child classification A hepatitis B
virus-related liver cirrhosis and gastric fundic varices (form 3). Gastric
varices were successfully treated with balloon-occluded retrograde transvenous
obliteration. Endoscopic 3 months after treatment reveals eradication of
gastric fundic varices.
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Copyright © 2001 by the American Roentgen Ray Society.
