1/245. Spontaneous cervical hematoma: a report of two cases.Cervical hematomas are generally associated with trauma, surgery, and tumors. Although they are rare, they can be life-threatening because they put the patient at risk for great-vessel compression and upper airway obstruction. We describe two cases of spontaneous cervical hematoma--one in an 81-year-old man and the other in a 30-year-old woman. The man reported dysphonia, dysphagia, and neck swelling of 5 hours' duration. He had been taking 100 mg/day of aspirin for a cardiovascular condition. Examination revealed that the man had polycythemia vera. The woman was found to have neck ache, odynophagia, and cervical ecchymosis; portal hypertension, schistosomiasis, and blood dyscrasia were also found. Both patients denied trauma. A suspected diagnosis of cervical hematoma was confirmed by computed tomography, and treatment was instituted. The hematomas resolved in about 2 weeks. The treatment of cervical hematoma is controversial, although it is agreed that the evaluation of upper airway obstruction and its permeability is mandatory. Surgical treatment is generally reserved for complicated cases because of the risk of infection or bleeding.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
2/245. Use of adrenal vein conduit for splenorenal shunts: a case report.We report a case with extrahepatic portal venous obstruction (EHPVO), who presented with recurrent bleeding following a previous devascularization procedure and needed an emergency distal spleno-renal shunt (DSRS). Due to technical difficulty because of previous scarring, the adrenal vein was used as a conduit between the splenic vein and renal vein. The shunt's patent and the patient has been bleed-free for 2 years.- - - - - - - - - - ranking = 0.5keywords = obstruction (Clic here for more details about this article) |
3/245. Portal hypertension secondary to arterio-portal fistulae: two unusual cases.A 62-year-old male presented with variceal haemorrhage. Investigation demonstrated a fistula between the left gastric artery and portal vein with a porto-systemic gradient of 35 mm Hg. Variceal bleeding was controlled by a transcatheter embolisation of the fistula, but the patient died of septicaemia three weeks later. The second patient, a 42-year-old male who presented with variceal bleeding was shown to have diffuse arterio-venous fistulae involving the right lobe of the liver with a portosystemic gradient of 25 mm Hg. In this case the variceal bleeding was successfully controlled by insertion of a transjugular intrahepatic portosystemic shunt (TIPS). The pathogenesis of portal hypertension in arterioportal fistulae and the role of interventional radiological techniques in the management of variceal bleeding in these patients is discussed.- - - - - - - - - - ranking = 1093.5271671126keywords = intrahepatic (Clic here for more details about this article) |
4/245. Segmental portal hypertension due to splenic vein obstruction: imaging findings and diagnostic pitfalls in four cases.Segmental portal hypertension due to isolated splenic vein obstruction is a rare but important entity as it is the only curable cause of portal hypertension by splenectomy. Four cases are presented illustrating the radiological features of splenic vein obstruction, and the diagnostic pitfalls that arose in patients with complicated clinical presentations.- - - - - - - - - - ranking = 3keywords = obstruction (Clic here for more details about this article) |
5/245. TIPS allowing for an endoscopic mucosal resection of early gastric cancer in a cirrhotic patient with severe hypertensive gastropathy: report of a case.This report describes the use of a transjugular intrahepatic portosystemic shunt (TIPS) in a cirrhotic patient with early gastric cancer, presenting with gastroesophageal varices and severe hypertensive gastropathy, in order to perform an endoscopic mucosal resection. The patient first underwent a TIPS to reduce the hypertensive gastropathy and thereafter was successfully treated by an endoscopic mucosal resection. Owing to the high operative risk, the treatment of gastric cancer in cirrhotic patients needs to be individualized. New procedures such as TIPS and an endoscopic mucosal resection may be useful in selected high-risk patients.- - - - - - - - - - ranking = 1093.5271671126keywords = intrahepatic (Clic here for more details about this article) |
6/245. Management of peri-operative pulmonary hypertension in a patient presenting for a portosystemic shunt.We report the successful management of intra-operative pulmonary hypertension in a patient with mitral valve insufficiency and portal hypertension. A 48-year-old male with portal hypertension presented for a portosystemic shunt. Previously undiagnosed mitral valve insufficiency and pulmonary hypertension complicated his anaesthetic management. His intra-operative course was marked by systolic hypotension, pulmonary hypertension and a reduction in cardiac output. The use of nitric oxide in this patient reduced right ventricular afterload, increased cardiac output, without exacerbating pre-existing systolic hypotension.- - - - - - - - - - ranking = 0.064084463235301keywords = duct (Clic here for more details about this article) |
7/245. color Doppler sonography in the diagnosis of neonatal intrahepatic portosystemic shunts.Intrahepatic portosystemic shunts are infrequent in children. We report 3 cases of neonates who presented with jaundice during the first month of life. color Doppler sonography in the first 2 cases showed direct communication between the right portal and hepatic veins. Both infants were asymptomatic, and the shunts disappeared spontaneously. The third case involved several shunts and an aberrant medial portal vein. This patient developed heart failure and died after surgery. color Doppler sonography was useful in the diagnosis and follow-up of the shunts in all 3 cases.- - - - - - - - - - ranking = 4374.1086684506keywords = intrahepatic (Clic here for more details about this article) |
8/245. Trans-anastomotic porto-portal varices in patients with gastrointestinal haemorrhage.AIM: Porto-portal varices are commonly seen in patients with segmental extra-hepatic portal hypertension and develop to provide a collateral circulation around an area of portal venous obstruction. It is not well recognized that such communications may also develop across surgical anastomoses and be the source of gastrointestinal haemorrhage. The possible mode of development of such communications has not been previously discussed. MATERIALS AND methods: Over a 3-year period between 1995 and 1998, porto-portal varices were demonstrated across surgical anastomoses in four patients who were referred for the investigation of acute (two), acute-on-chronic (one) and chronic gastrointestinal bleeding (one). Their medical notes and the findings at angiography were reviewed. RESULTS: Three patients had segmental portal hypertension due to extra-hepatic portal vein (one) or superior mesenteric vein (two) stenosis/occlusion. One patient had mild portal hypertension due to hepatic fibrosis secondary to congenital biliary atresia. At angiography all patients were shown to have varices crossing previous surgical anastomoses. These varices were presumed to be the cause of bleeding in three of the four patients; the site of bleeding in the fourth individual was not determined. CONCLUSIONS: Trans-anastomotic porto-portal varices are rare. They develop in the presence of extra-hepatic portal hypertension and presumably arise within peri-anastomotic inflammatory tissue. Such varices may be difficult to manage and their prognosis is poor when bleeding occurs.- - - - - - - - - - ranking = 0.5keywords = obstruction (Clic here for more details about this article) |
9/245. Successful treatment of chronic budd-chiari syndrome with a transjugular intrahepatic portosystemic shunt.budd-chiari syndrome is characterized by obstruction of the hepatic venous outflow tract. Therapeutic options for chronic budd-chiari syndrome are limited. We report the case of a 28-year-old woman who presented with recurrence of chronic budd-chiari syndrome with total obstruction of all major hepatic veins. Due to worsening liver function over the course of 1 year, she had to be listed for liver transplantation. Because of therapy-refractory ascites, declining renal function and severe esophageal varices, a transjugular intrahepatic portosystemic shunt (TIPS) was placed, planned as a bridge to transplantation. Following TIPS, a marked recovery of liver function could be observed, accompanied by disappearance of ascites, esophageal varices, and normalization of kidney function. Therefore, the patient could be removed from the waiting list for liver transplantation. This case demonstrates for the first time that the use of TIPS in chronic budd-chiari syndrome may result in marked recovery of liver function.- - - - - - - - - - ranking = 5468.6358355632keywords = intrahepatic, obstruction (Clic here for more details about this article) |
10/245. Transjugular intrahepatic portosystemic shunt for trauma?We report a case of successful emergency TIPS placement to control intra-abdominal bleeding after blunt abdominal trauma in a patient with severe cirrhosis and portal hypertension.- - - - - - - - - - ranking = 4374.1086684506keywords = intrahepatic (Clic here for more details about this article) |
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