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Related Experiment Videos

Active intrahepatic gadolinium extravasation following TIPS

S Hasegawa1, L B Eisenberg, R C Semelka

  • 1Department of Radiology, Hamamatsu Medical Center, Japan.

Magnetic Resonance Imaging
|November 12, 1998
PubMed
Summary

A patient with paroxysmal nocturnal hemoglobinuria (PNH) developed abdominal pain after a transjugular intrahepatic portal systemic shunt (TIPS). Magnetic resonance imaging (MRI) revealed active bleeding from a hematoma, confirmed by angiography.

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Area of Science:

  • Interventional Radiology
  • Vascular Imaging
  • Hepatology

Background:

  • Transjugular intrahepatic portal systemic shunt (TIPS) placement is a treatment for portal hypertension.
  • Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disorder that can lead to thrombosis.
  • Budd-Chiari syndrome is a hepatic vascular disease caused by obstruction of hepatic venous outflow.

Observation:

  • A 31-year-old male with PNH underwent TIPS for Budd-Chiari syndrome.
  • Post-TIPS, the patient developed upper abdominal pain and was anticoagulated.
  • Magnetic resonance imaging (MRI) demonstrated active gadolinium extravasation in an intrahepatic hematoma.

Findings:

  • Spoiled-gradient-echo (SGE) MRI sequences showed gadolinium layering within the hematoma, indicating active arterial bleeding.

Related Experiment Videos

  • The active bleeding was confirmed by conventional angiography.
  • This case highlights a rare complication following TIPS in a PNH patient.

    • Implications:

    • Early detection of post-TIPS bleeding is crucial for patient management.
    • MRI with dynamic contrast enhancement can identify active hemorrhage.
    • Understanding the interplay between PNH, TIPS, and bleeding complications is important for clinicians.