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CO2 Splenoportography: Preliminary Results

James G. Caridi1, Irvin F. Hawkins, Jr.1, Kyung Cho2, Steven Y. Sohn1, Max R. Langham, Jr.3, Bret N. Weichmann4 and Scott D. Klioze1

1 Department of Radiology, University of Florida College of Medicine, 1600 S.W. Archer Rd., P. O. Box 100374, Gainesville, FL 32610-0374.
2 Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0001.
3 Department of Surgery, University of Florida College of Medicine, P. O. Box 110240, Gainesville, FL 32610-0240.
4 Department of Radiology, North Florida Regional Medical Center, I-75 and Newberry Rd., Gainesville, FL 32614.



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  		Fig. 1. —CO2 splenoportogram in 2-year-old girl with biliary atresia shows patent splenic (thin solid arrow) and intrahepatic veins and small portal vein (thick solid arrow). Note reflux in superior (open arrow) and inferior (curved arrow) mesenteric veins. Sonography and MR angiography (not shown) showed no portal vein.

 


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  		Fig. 2A. —5-month-old boy with biliary atresia. CO2 splenoportogram shows splenic superior mesenteric vein (thick solid arrows), coronary and gastroesophageal varices (thin solid arrow), and patent diminutive portal veins (open arrow), which were incorrectly interpreted as collateral vein. CO2 injection was performed with patient in Trendelenburg's position.

 


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  		Fig. 2B. —5-month-old boy with biliary atresia. Splenoportogram shows needle in spleen (curved arrow) and CO2 filling inferior vena cava (open arrow) via multiple retroperitoneal collateral veins (thick solid arrow). Coronary collateral veins (thin solid arrow) also fill. No filling of either superior mesenteric or portal veins was revealed.

 


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  		Fig. 3. —CO2 splenoportography in 9-year-old girl postsplenorenal shunt with 25-gauge needle (thick solid arrow) in spleen shows cavernous transformation of portal vein (open arrow) and short gastric collateral veins (thin solid arrow) with no evidence of splenorenal shunt. CT (not shown) revealed patent shunt.

 


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  		Fig. 4. —2-year-old boy with recurrent hepatoblastoma and occluded portal vein who had undergone trisegmentectomy. CO2 splenoportogram shows splenic vein as patent (thick solid arrow). Large hypogastric collateral vein (thin solid arrow) fills inferior vena cava (open arrow).

 

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