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Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography
Insights
Imaging techniques like computed tomography (CT) and ultrasound reveal distinct changes in hepatic vein occlusion. These methods help identify liver morphologic alterations associated with acute, subacute, and chronic venous blockages.
Area of Science:
- Radiology
- Hepatology
- Vascular Imaging
Background:
- Hepatic vein occlusion leads to significant morphologic liver changes.
- Computed tomography (CT) and ultrasound are key imaging modalities for diagnosis.
Observation:
- Retrospective analysis of 9 patients with acute, subacute, and chronic hepatic vein occlusion.
- CT demonstrated focal/scattered hypodense lesions and patchy enhancement post-contrast; hepatic veins were not visualized.
- Ultrasound revealed intraluminal material in hepatic veins, intrahepatic collaterals, and stage-dependent parenchymal lesions (hypoechogenic in acute, hyperechogenic in chronic).
Findings:
- Hepatomegaly with caudate lobe enlargement was consistently observed.
- Acute thrombosis presented with hypoechogenic areas due to hemorrhagic infarction.
- Chronic disease showed hyperechogenic lesions indicative of fibrotic changes.
- Ascites was present in all patients across all stages.
Implications:
- CT and ultrasound findings provide valuable insights into the progression of hepatic vein occlusion.
- Imaging characteristics correlate with underlying histopathologic changes, aiding diagnosis.
- These imaging techniques are essential for characterizing the extent and stage of hepatic vein occlusion and associated complications.
Abstract:
Hepatic vein occlusion causes morphologic changes that can be demonstrated by computed tomography (CT) and ultrasound. In this study the imaging findings of acute, subacute, and chronic occlusion of the hepatic veins were analyzed retrospectively in 9 patients and correlated with the histopathologic changes. The CT findings were focal or scattered hypodense parenchymal lesions of the liver before and a patchy enhancement after intravenous bolus injection of contrast material. In none of the cases could the hepatic veins be identified. Hepatomegaly with relative enlargement of the caudate lobe was almost always observed. Ultrasonography demonstrated solid material within the major hepatic veins, intrahepatic venous collaterals, and focal parenchymal lesions, which varied with the stage of the disease: a hypoechogenic area was observed in acute hepatic vein thrombosis with subsequent hemorrhagic infarction; hyperechogenic lesions corresponded with fibrotic zones in chronic disease. Ascites was shown by both methods in all patients.