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Pylephlebitis After CT-Guided Percutaneous Liver Biopsy

¹ Department of Medicine, Caritas St. Elizabeth's Medical Center, Boston, MA 02135.
² Department of Radiology, Caritas St. Elizabeth's Medical Center, Boston, MA 02135.
³ Division of Infectious Diseases, Caritas St. Elizabeth's Medical Center, 736 Cambridge St., Boston, MA 02135.

View larger version (126K): [in a new window]   Fig. 1A. —Hepatic metastasis from VIPoma in 46-year-old woman. CT scan shows hepatic metastasis (thick arrow) close to jejunal aspect of choledochojejunostomy (two thin arrows). Portal vein branch to anterior segment of right lobe is patent (single thin arrow).

View larger version (128K): [in a new window]   Fig. 1B. —Hepatic metastasis from VIPoma in 46-year-old woman. CT-guided needle biopsy, with needle adjacent to metastasis (thick arrow), in close proximity to choledochojejunostomy site (two thin arrows).

View larger version (129K): [in a new window]   Fig. 1C. —Hepatic metastasis from VIPoma in 46-year-old woman. Pylephlebitis after CT-guided percutaneous liver biopsy. CT scan 1 week after needle biopsy (C) reveals portal vein thrombosis of anterior segmental branch to previously patent right lobe (single thin arrow). CT scan 1 week after needle biopsy (D) with portal vein thrombosis, multicentric perfusion defects, and extensive involvement of segment VII (thin arrows). CT scan 6 months after biopsy (E) shows improved perfusion but persistent thrombosis in one portal radicle (thin arrow). No intrahepatic biliary dilatation is noted. Thick arrow in C denotes hepatic metastasis.

View larger version (125K): [in a new window]   Fig. 1D. —Hepatic metastasis from VIPoma in 46-year-old woman. Pylephlebitis after CT-guided percutaneous liver biopsy. CT scan 1 week after needle biopsy (C) reveals portal vein thrombosis of anterior segmental branch to previously patent right lobe (single thin arrow). CT scan 1 week after needle biopsy (D) with portal vein thrombosis, multicentric perfusion defects, and extensive involvement of segment VII (thin arrows). CT scan 6 months after biopsy (E) shows improved perfusion but persistent thrombosis in one portal radicle (thin arrow). No intrahepatic biliary dilatation is noted. Thick arrow in C denotes hepatic metastasis.

View larger version (129K): [in a new window]   Fig. 1E. —Hepatic metastasis from VIPoma in 46-year-old woman. Pylephlebitis after CT-guided percutaneous liver biopsy. CT scan 1 week after needle biopsy (C) reveals portal vein thrombosis of anterior segmental branch to previously patent right lobe (single thin arrow). CT scan 1 week after needle biopsy (D) with portal vein thrombosis, multicentric perfusion defects, and extensive involvement of segment VII (thin arrows). CT scan 6 months after biopsy (E) shows improved perfusion but persistent thrombosis in one portal radicle (thin arrow). No intrahepatic biliary dilatation is noted. Thick arrow in C denotes hepatic metastasis.

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