Poster Author of 2 e-Posters
EE-100 - A Pictorial Review Of Portal Hypertension
EE-136 - Don't Forget The Chest!
Author of 2 Presentations
EE-100 - A Pictorial Review Of Portal Hypertension
Abstract
Objectives
To review the imaging features of portal hypertension to aid early diagnosis and treatment
Background
Portal hypertension is defined as a pathological increase in portal venous pressure above 10mmHg due to increased resistance to portal blood flow. This can occur at the level of the portal vein (pre-sinusoidal), hepatic sinusoid or hepatovenous outflow tracts (post-sinusoidal). A consequence of persistent increased portal venous pressure is the formation of collateral pathways as blood circumvents the liver to pass through lower resistance porto-systemic channels. We aim to describe the sonographic and cross-sectional imaging features of portal hypertension.
Imaging findings OR Procedure findings
Sonographic features of portal hypertension can include a dilated portal vein, biphasic or reversed portal flow, splenomegaly, ascites as well as porto–systemic collateral pathways. Less commonly, a recanalised umbilical vein is identified sonographically. Collateral vessels are numerous and more readily identified on cross-sectional imaging. Common sites of collateralisation such as gastric, paraoesophageal, perisplenic and anorectal vessels are described as well as less common collaterals such as splenorenal and gastrorenal shunting, paravertebral, pericardiphrenic and retroperitoneal pathways. Uncommon collateral pathways have been linked to an increased Child-Pugh score. Sonography and cross-sectional imaging can also identify possible causes of portal hypertension including cirrhosis, portal vein thrombosis and Budd-Chiari syndrome.
Conclusion
Portal hypertension is a commonly encountered clinical condition and awareness of its radiological appearance such as collateral pathways can aid initiation of treatment and reduce the development of potentially devastating consequences such as variceal bleeding, portal colopathy and hepatic encephalopathy.
EE-136 - Don't Forget The Chest!
Abstract
Objectives
A pictorial review of uncommon incidental basal thoracic pathology identified or identifiable on abdominal CT
Background
The lower thorax is incidentally imaged in abdominal CT protocols to ensure adequate coverage of the liver and spleen. The degree of coverage can differ due to variability in patient respiration and anatomy as well as radiographer technique. Although an abdominal CT is not a dedicated form of imaging to comprehensively evaluate the thorax, in some cases a considerable proportion of the lower thorax can be imaged and therefore we are obliged to assess this region. We present a series of unusual, yet significant, basal thoracic pathology diagnosed, or identifiable, on abdominal CT.
Imaging findings OR Procedure findings
The abdominal CT commonly extends sufficiently cranially to include the lower lobes of the lungs, cardiac chambers and lower mediastinum as well as a significant proportion of the lower ribs and thoracic spine. Cardiovascular pathology incidentally diagnosed on abdominal CT at our Trust includes left ventricular thrombus, atrial myxoma, pericardial effusion and a thoraco-abdominal aortic aneurysm. Pulmonary nodules and primary lung malignancies are also identified on evaluation of the lung bases as well as lower lobar pulmonary emboli, empyema and bronchopneumonia. Peripheral pulmonary consolidation can be also be recognised as a manifestation of pulmonary infarct, prompting dedicated CT chest imaging. We must also be aware that lower rib and thoracic vertebral metastases are also potentially identifiable on limited imaging of the chest on abdominal CT.
Conclusion
The abdominal CT offers the opportunity to identify significant thoracic pathology which can prompt further imaging and treatment.