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Cardiophrenic varices in portal hypertension: evaluation with CT
R H Wachsberg1, V Yaghmai, B R Javors
1Department of Radiology, University Hospital, Newark, NJ 07103, USA.
Insights
Cardiophrenic angle (CPA) varices are common in patients with portal hypertension (PHT). These findings on computed tomography (CT) may mimic masses, necessitating delayed imaging for accurate diagnosis.
Area of Science:
- Radiology
- Gastroenterology
- Vascular Imaging
Background:
- Portal hypertension (PHT) is a serious complication of liver disease.
- Cardiophrenic angle (CPA) masses can be challenging to diagnose.
- Understanding the imaging features of CPA varices is crucial.
Purpose of the Study:
- To determine the prevalence of CPA varices on CT in patients with PHT.
- To describe the imaging appearance of CPA varices.
- To assess the utility of delayed CT in diagnosing CPA varices.
Main Methods:
- Retrospective review of 148 contrast-enhanced abdominal CT scans in patients with PHT.
- Assessment of the paracardiac region for tubular structures suggestive of varices.
- Measurement of variceal diameter and CT attenuation.
Main Results:
- CPA varices were identified in 29 patients (19.6%), more frequently on the right.
- Mean CPA varix diameter was 2.6 mm.
- Delayed CT demonstrated enhancement in CPA varices, reflecting delayed portal venous enhancement.
Conclusions:
- CPA varices are not uncommon in PHT and can mimic CPA masses.
- Consideration of CPA varices is important before procedures like percutaneous biopsy.
- Delayed CT imaging can aid in the definitive diagnosis of CPA varices.
Purpose:
To determine the prevalence and appearance of cardiophrenic angle (CPA) varices at computed tomography (CT) in patients with portal hypertension (PHT).
Materials And Methods:
A retrospective review was performed of 148 consecutive contrast material--enhanced abdominal CT scans of patients with PHT. The paracardiac region was assessed for tubular structures suggestive of varices. Variceal diameter and CT attenuation relative to adjacent liver were noted.
Results:
Tubular structures consistent with CPA varices were noted in 29 cases and were more common on the right side than on the left. Mean CPA variceal diameter was 2.6 mm. In three cases, right CPA varices measured 10-13 mm in diameter, but no variceal enhancement was noted on initial dynamic CT images. Delayed CT demonstrated contrast enhancement that reflected delayed enhancement of the portal venous system.
Conclusion:
CPA varices, particularly on the right side, are not uncommon in patients with PHT. Varices should be considered and excluded as a cause of CPA masses, particularly before percutaneous biopsy. Delayed CT may be necessary to correctly delineate CPA varices.