BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this...BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this condition remains a clinical challenge.CASE SUMMARY We present three cases of asymptomatic PVA;the first and second involve an extrahepatic manifestation,of 48 mm and 42.3 mm diameter respectively,and the third involves an intrahepatic PVA of 27 mm.All were diagnosed incidentally during routine check-up,upon ultrasonography scan.Since all patients were asymptomatic,a conservative treatment strategy was chosen.Follow-up imaging demonstrated no progression in the aneurysm dimension for any case.CONCLUSION As PVA remains asymptomatic in many cases,recognition of its imaging features is key to favourable outcomes.展开更多
We report two cases of extrahepatic portal vein aneurysm,and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Phy...We report two cases of extrahepatic portal vein aneurysm,and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Physical examination revealed nothing abnormal. Both of them were diagnosed by magnetic resonance imaging angiography (MRA). One of the aneurysms was located at the main portal vein, the other, at the confluence of the superior mesenteric vein and the splenic vein, and these two places are exactly the most common locations of the extrahepatic portal vein aneurysm reported in the literature (30.7% each site). The first case underwent aneurysmorrhaphy and the second case, aneurysm resection with splenectomy. Both of them recovered soon after the operation, and the symptom of the first case was greatly alleviated. During the follow-up of half a year, no complication and adverse effect of surgical intervention was found and the color Doppler ultrasonography revealed no recurrence of the aneurysmal dilation. We suggest that surgical intervention can alleviate the symptom of the extrahepatic portal vein aneurysm and prevent its complications effectively and safely for low risk patients.展开更多
A 65-year-old woman with Budd-Chiari syndrome(BCS) presented with right upper quadrant pain.A computed tomography(CT) scan showed a saccular aneurysm located at the extrahepatic portal vein main branch measuring 3.2 c...A 65-year-old woman with Budd-Chiari syndrome(BCS) presented with right upper quadrant pain.A computed tomography(CT) scan showed a saccular aneurysm located at the extrahepatic portal vein main branch measuring 3.2 cm in height and 2.5 cm × 2.4 cm in diameter.The aneurysm was thought to be associatedwith BCS as there was no preceding history of trauma and it had not been present on Doppler ultrasound examination performed 3 years previously.Because of increasing pain and concern for complications due to aneurysm size, the decision was made to relieve the hepatic venous outflow obstruction.Transjugular intrahepatic portosystemic shunt(TIPS) was created without complications.She had complete resolution of her abdominal pain within 2 d and remained asymptomatic after 1 year of follow-up.CT scans obtained after TIPS showed that the aneurysm had decreased in size to 2.4 cm in height and 2.0 cm × 1.9 cm in diameter at 3 mo, and had further decreased to 1.9 cm in height and 1.6 cm × 1.5 cm in diameter at 1 year.展开更多
A 60-year-old male underwent orthotopic liver trans- plantation because of hepatitis C virus related cirrhosis. After 12 d,the patient underwent re-transplantation due to primary graft non function.One year later the ...A 60-year-old male underwent orthotopic liver trans- plantation because of hepatitis C virus related cirrhosis. After 12 d,the patient underwent re-transplantation due to primary graft non function.One year later the patient developed a thrombosis of the main portal vein needing a surgical revision.After 11 years the patient was operated on because of a clinical picture of intestinal occlusion.As an incidental finding,a large aneurysm of the main portal vein was diagnosed.The incidence of intra-and extrahepatic Portal vein aneurysms(PVAs) is not clear.To the best of our knowledge,only one case of intrahepatic PVA in a liver transplant has been reported in the literature.In addition,we have found no documented cases of extrahepatic PVAs in liver transplanted patients.展开更多
Extrahepatic portal vein aneurysm (PVA) is very rare with only 17 previously reported cases.Methods of treatment include resection,thrombectomy,and portal venous decompression.We report herein the first case of large ...Extrahepatic portal vein aneurysm (PVA) is very rare with only 17 previously reported cases.Methods of treatment include resection,thrombectomy,and portal venous decompression.We report herein the first case of large PVA with thrombosis which has been managed without surgical treatment over a long period.A PVA was detected in a 78-year-old woman by abdominal ultrasonography.Computed tomography revealed an aneurysm of 6 cm in a diameter in the porta hepatis.Portal venography showed obstruction of the portal vein and developed collateral vessels around the aneurysm.Since the patient had no symptoms of portal hypertension,we decided to carefully manage her clinical course without surgical treatment.At present,this patient is healthy and has developed no complications over the 5 years since leaving our hospital.This case suggests that surgical treatment is not required for PVA without portal hypertension.展开更多
BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological fa...BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.展开更多
Portal venous aneurysm (PVA) is a rare condition characterized by dilatation of the portal venous system. PVA manifestation of symptoms is varied and depends on the aneurysm size, location and related-complications, s...Portal venous aneurysm (PVA) is a rare condition characterized by dilatation of the portal venous system. PVA manifestation of symptoms is varied and depends on the aneurysm size, location and related-complications, such as thrombosis. While the majority of reported cases of PVA are attributed to portal hypertension, very little is known about the condition's pathophysiology and clinical management remains a challenge. Here, we describe a 67-year-old woman who presented with complaint of dyspepsia and without a significant medical history, for whom PVA was incidentally diagnosed. The initial upper abdominal ultrasound revealed marked dilatation of the main portal vein, and subsequent contrast-enhanced computed tomography with angiography revealed a large aneurysm arising from the extrahepatic troncus portion of the portal vein, as well as gastroesophageal varices. A conservative approach using beta-blocker therapy was chosen. The patient was followed-up for 60 mo, during which time the asymptomatic status was unaltered and the PVA remained stable.展开更多
文摘BACKGROUND Portal vein aneurysm(PVA)is an uncommon vascular dilatation,showing no clear trend in sex or age predominance.Due to the low number of published cases and the lack of management guidelines,treatment of this condition remains a clinical challenge.CASE SUMMARY We present three cases of asymptomatic PVA;the first and second involve an extrahepatic manifestation,of 48 mm and 42.3 mm diameter respectively,and the third involves an intrahepatic PVA of 27 mm.All were diagnosed incidentally during routine check-up,upon ultrasonography scan.Since all patients were asymptomatic,a conservative treatment strategy was chosen.Follow-up imaging demonstrated no progression in the aneurysm dimension for any case.CONCLUSION As PVA remains asymptomatic in many cases,recognition of its imaging features is key to favourable outcomes.
文摘We report two cases of extrahepatic portal vein aneurysm,and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Physical examination revealed nothing abnormal. Both of them were diagnosed by magnetic resonance imaging angiography (MRA). One of the aneurysms was located at the main portal vein, the other, at the confluence of the superior mesenteric vein and the splenic vein, and these two places are exactly the most common locations of the extrahepatic portal vein aneurysm reported in the literature (30.7% each site). The first case underwent aneurysmorrhaphy and the second case, aneurysm resection with splenectomy. Both of them recovered soon after the operation, and the symptom of the first case was greatly alleviated. During the follow-up of half a year, no complication and adverse effect of surgical intervention was found and the color Doppler ultrasonography revealed no recurrence of the aneurysmal dilation. We suggest that surgical intervention can alleviate the symptom of the extrahepatic portal vein aneurysm and prevent its complications effectively and safely for low risk patients.
基金Supported by National Natural Science Fund of China,No.81371656 and No.81171444 to Xiao Li
文摘A 65-year-old woman with Budd-Chiari syndrome(BCS) presented with right upper quadrant pain.A computed tomography(CT) scan showed a saccular aneurysm located at the extrahepatic portal vein main branch measuring 3.2 cm in height and 2.5 cm × 2.4 cm in diameter.The aneurysm was thought to be associatedwith BCS as there was no preceding history of trauma and it had not been present on Doppler ultrasound examination performed 3 years previously.Because of increasing pain and concern for complications due to aneurysm size, the decision was made to relieve the hepatic venous outflow obstruction.Transjugular intrahepatic portosystemic shunt(TIPS) was created without complications.She had complete resolution of her abdominal pain within 2 d and remained asymptomatic after 1 year of follow-up.CT scans obtained after TIPS showed that the aneurysm had decreased in size to 2.4 cm in height and 2.0 cm × 1.9 cm in diameter at 3 mo, and had further decreased to 1.9 cm in height and 1.6 cm × 1.5 cm in diameter at 1 year.
文摘A 60-year-old male underwent orthotopic liver trans- plantation because of hepatitis C virus related cirrhosis. After 12 d,the patient underwent re-transplantation due to primary graft non function.One year later the patient developed a thrombosis of the main portal vein needing a surgical revision.After 11 years the patient was operated on because of a clinical picture of intestinal occlusion.As an incidental finding,a large aneurysm of the main portal vein was diagnosed.The incidence of intra-and extrahepatic Portal vein aneurysms(PVAs) is not clear.To the best of our knowledge,only one case of intrahepatic PVA in a liver transplant has been reported in the literature.In addition,we have found no documented cases of extrahepatic PVAs in liver transplanted patients.
文摘Extrahepatic portal vein aneurysm (PVA) is very rare with only 17 previously reported cases.Methods of treatment include resection,thrombectomy,and portal venous decompression.We report herein the first case of large PVA with thrombosis which has been managed without surgical treatment over a long period.A PVA was detected in a 78-year-old woman by abdominal ultrasonography.Computed tomography revealed an aneurysm of 6 cm in a diameter in the porta hepatis.Portal venography showed obstruction of the portal vein and developed collateral vessels around the aneurysm.Since the patient had no symptoms of portal hypertension,we decided to carefully manage her clinical course without surgical treatment.At present,this patient is healthy and has developed no complications over the 5 years since leaving our hospital.This case suggests that surgical treatment is not required for PVA without portal hypertension.
文摘BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.
文摘Portal venous aneurysm (PVA) is a rare condition characterized by dilatation of the portal venous system. PVA manifestation of symptoms is varied and depends on the aneurysm size, location and related-complications, such as thrombosis. While the majority of reported cases of PVA are attributed to portal hypertension, very little is known about the condition's pathophysiology and clinical management remains a challenge. Here, we describe a 67-year-old woman who presented with complaint of dyspepsia and without a significant medical history, for whom PVA was incidentally diagnosed. The initial upper abdominal ultrasound revealed marked dilatation of the main portal vein, and subsequent contrast-enhanced computed tomography with angiography revealed a large aneurysm arising from the extrahepatic troncus portion of the portal vein, as well as gastroesophageal varices. A conservative approach using beta-blocker therapy was chosen. The patient was followed-up for 60 mo, during which time the asymptomatic status was unaltered and the PVA remained stable.
