Inferior Phrenic Arterial Bleeding After Adult Liver Transplantation: Incidence, Clinical Manifestations, and Predictive CT Features
Seong Sook Hong1,
Ah Young Kim1,
Hye Jin Kim1,
Kyung Won Kim1,
Seung Gyu Lee2,
Pyo Nyun Kim1,
Moon-Gyu Lee1 and
Hyun Kwon Ha1
1 Department of Radiology, Asan Medical Center, University of Ulsan College of
Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, South Korea 138-736.
2 Department of Surgery, Asan Medical Center, University of Ulsan College of
Medicine, Seoul, South Korea.
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Fig. 1A —47-year-old woman with a sudden bloody discharge from the
drainage tube 4 days after orthotopic liver transplantation. Unenhanced
(A) and contrast-enhanced (B) axial CT images show a localized
fluid collection with high attenuation (55 H) posteromedial to transplanted
liver, suggesting acute hematoma (arrows). All high-attenuation lines
on A and B suggest surgical drainage tubes.
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Fig. 1B —47-year-old woman with a sudden bloody discharge from the
drainage tube 4 days after orthotopic liver transplantation. Unenhanced
(A) and contrast-enhanced (B) axial CT images show a localized
fluid collection with high attenuation (55 H) posteromedial to transplanted
liver, suggesting acute hematoma (arrows). All high-attenuation lines
on A and B suggest surgical drainage tubes.
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Fig. 1C —47-year-old woman with a sudden bloody discharge from the
drainage tube 4 days after orthotopic liver transplantation. Anteroposterior
arteriogram of right inferior phrenic artery shows extravasation
(arrow) of contrast medium from this artery. This bleeding was
controlled by embolization with microcoils.
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Fig. 2A —25-year-old man with sudden decrease in hemoglobin level 11
days after left-lobe transplantation from a living donor. Contrast-enhanced
axial CT scan obtained from hepatic venous phase shows active extravasation of
contrast material (arrows) from dilated right inferior phrenic artery
(arrowhead). Splenic infarction is also noted.
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Fig. 2B —25-year-old man with sudden decrease in hemoglobin level 11
days after left-lobe transplantation from a living donor. Subsequent
conventional angiography reveals similar imaging features.
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Fig. 3A —45-year-old man with sudden hypotensive crisis 10 days after
right-lobe transplantation from a living donor. High-attenuated fluid
collection (arrows, A) is noted posterior to transplanted
liver on both axial CT images obtained from arterial (A) and portal
venous (B) phases. However, active leakage of contrast medium (open
arrow, B) from right IPA is seen on portal venous phase alone
(B).
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Fig. 3B —45-year-old man with sudden hypotensive crisis 10 days after
right-lobe transplantation from a living donor. High-attenuated fluid
collection (arrows, A) is noted posterior to transplanted
liver on both axial CT images obtained from arterial (A) and portal
venous (B) phases. However, active leakage of contrast medium (open
arrow, B) from right IPA is seen on portal venous phase alone
(B).
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Copyright © 2006 by the American Roentgen Ray Society.
