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[Predictive value of ultrasonography in portal hypertension]
1Servicio de Gastroenterología y Cirugía Pediátrica, Hospital de Niños J. M. de los Ríos, Caracas, Venezuela.
Insights
Portal hypertension in children, often caused by portal vein cavernomatosis, can lead to dangerous esophageal varices. A simple ultrasound measurement of the lesser omentum to aorta ratio shows diagnostic promise for this condition.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Diagnostic Imaging
Background:
- Portal hypertension is a significant pediatric condition, frequently stemming from portal vein cavernomatosis.
- This obstruction triggers hemodynamic shifts, resulting in splenomegaly and the development of collateral circulation.
- Esophageal varices are a critical complication, posing a life-threatening bleeding risk.
Purpose of the Study:
- To evaluate the diagnostic utility of the lesser omentum/aorta ratio in pediatric portal hypertension.
- To assess the severity of esophageal varices in children with portal vein cavernomatosis.
- To compare ultrasound findings with endoscopic results in affected children.
Main Methods:
- Abdominal ultrasonography and upper GI endoscopy were performed on 15 children with portal hypertension due to portal vein cavernomatosis.
- The lesser omentum/aorta ratio was measured using ultrasonography.
- Esophageal varices were graded via endoscopy.
Main Results:
- Endoscopy revealed grade II esophageal varices in 20% of cases, with 80% showing grade III and IV varices.
- Ultrasonography demonstrated a significantly increased lesser omentum/aorta ratio in children with portal hypertension compared to controls (p < 0.001).
Conclusions:
- The lesser omentum/aorta ratio, assessed via ultrasonography, holds significant diagnostic value for pediatric portal hypertension.
- This non-invasive imaging marker aids in identifying hemodynamic changes associated with the condition.
- Ultrasonography provides a valuable tool for evaluating children with suspected or confirmed portal hypertension.
Abstract:
Portal hypertension is a common pathology in childhood and one of its most common causes is cavernomatosis of the portal vein. This obstruction causes hemodynamic changes which lead to splenomegaly and collateral circulation. Esophageal varices are one of the most important sequelae, which endanger the patient's life because of a bleeding tendency. Ecosonography helps to detect the thickening of the lesser omentum vis a vis the aortic diameter, caused by the collateral circulation. We studied 15 children presenting with portal hypertension resulting from portal vein cavernomatosis; we performed an upper GI endoscopy and abdominal ecosonography. The endoscopy revealed grade II esophageal varices in 20% of cases, the remaining 80% had grade III and grade IV. Ecosonography revealed an increased lesser omentum/aorta ratio in children with portal hypertension, compared to controls (p < 0.001). Our results suggest that the lesser omentum/aorta ratio has diagnostic value in pediatric portal hypertension.