Portosystemic collateral pathways
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At the time the article was created Donna D'Souza had no recorded disclosures.
View Donna D'Souza's current disclosuresAt the time the article was last revised Nicholas Verikios had no financial relationships to ineligible companies to disclose.
View Nicholas Verikios's current disclosures- Porto-systemic collateral pathways
- Portal-systemic collaterals
- Porto-systemic collaterals
- Portosystemic shunts
- Porto-systemic shunts
- Porto-systemic shunt
- Portal-systemic collateral pathways
- Portosystemic collaterals
- Portosystemic collateral pathways
- Portosystemic shunt
- Varices (portosystemic shunts)
- Spontaneous portosystemic shunt
- Spontaneous portosystemic shunts
Portosystemic collateral pathways, also called spontaneous portosystemic shunts or varices, develop spontaneously via dilatation of pre-existing anastomoses between the portal and systemic venous systems. This facilitates shunting of blood away from the liver into the systemic venous system in portal hypertension, as a means for reducing portal venous pressure. However, these are not sufficient for normalizing portal venous pressure.
The main sites of portosystemic collateral pathways are:
-
left gastric (see gastric varices)
left gastric (coronary) vein and short gastric veins to distal esophageal veins
located between medial wall of gastric body and posterior margin of left hepatic lobe in lesser omentum
usually accompanied by esophageal/paraesophageal varices (see below)
esophageal: dilated submucosal venous plexus of distal esophagus (see esophageal varices)
-
paraesophageal
coronary vein to azygos and hemiazygos veins and vertebral venous plexus
located posterior to esophagus in posterior mediastinum
perisplenic: splenic vein to left renal vein, traversing splenocolic ligament; may eventuate in a spontaneous splenorenal shunt
-
retrogastric
left gastric (coronary) vein or gastroepiploic vein to esophageal or paraesophageal veins
located in posterior/posteromedial aspect of gastric fundus
retroperitoneal-paravertebral: colic or mesenteric branches of superior mesenteric vein to retroperitoneal/lumbar veins to the inferior vena cava
paraumbilical: left portal vein to paraumbilical veins in anterior ridge of falciform ligament
anterior abdominal wall: paraumbilical and omental veins to subcutaneous periumbilical veins and superior and inferior epigastric veins; collaterals appear to radiate from the umbilicus (caput medusae)
mesenteric: dilated branches of superior mesenteric vein
anal canal: superior rectal vein (from the inferior mesenteric vein) to upper anal canal veins (hemorrhoids)
Differential diagnosis
Dilatation of splenic veins at the splenic hilum mimicking splenic hilar varices without splenomegaly may occur in situations such as increased perfusion of splenic tissue associated with an immune response 4.
References
- 1. Kaufman JA, Lee MJ. Vascular & interventional radiology. Mosby Inc. (2004) ISBN:0815143699. Read it at Google Books - Find it at Amazon
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- 3. Schuenke M, Schulte E, Schumacher U et-al. Neck and Internal Organs. Thieme. ISBN:1604062940. Read it at Google Books - Find it at Amazon
- 4. Stella SM, Giunta S, Galetta F et-al. Dilation of venous vessels at the splenic hilum in normal sized spleens as an indication of pathologic splenic involvement: preliminary results. J Ultrasound Med. 1993;12 (6): 349-53. Pubmed citation
- 5. Sharma M, Rameshbabu CS. Collateral pathways in portal hypertension. Journal of clinical and experimental hepatology. 2 (4): 338-52. doi:10.1016/j.jceh.2012.08.001 - Pubmed
- 6. Lee W, Chang S, Duddalwar V et al. Imaging Assessment of Congenital and Acquired Abnormalities of the Portal Venous System. Radiographics. 2011;31(4):905-26. doi:10.1148/rg.314105104 - Pubmed
- 7. Stephanie Ryan, Michelle McNicholas, Stephen J. Eustace. Anatomy for Diagnostic Imaging. (2011). ISBN: 9780702029714 - Google Books
- 8. Nardelli S, Riggio O, Turco L et al. Relevance of Spontaneous Portosystemic Shunts Detected with CT in Patients with Cirrhosis. Radiology. 2021;299(1):133-40. doi:10.1148/radiol.2021203051 - Pubmed
- 9. Philips C, Arora A, Shetty R, Kasana V. A Comprehensive Review of Portosystemic Collaterals in Cirrhosis: Historical Aspects, Anatomy, and Classifications. Int J Hepatol. 2016;2016:1-15. doi:10.1155/2016/6170243 - Pubmed
- 10. Grant E, Tessler F, Gomes A et al. Color Doppler Imaging of Portosystemic Shunts. AJR Am J Roentgenol. 1990;154(2):393-7. doi:10.2214/ajr.154.2.2105035 - Pubmed
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- Idiopathic non-cirrhotic portal hypertension
- Upper gastrointestinal bleeding (differential)
- Splenic vein
- Hepatic encephalopathy
- Caroli disease
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- Transjugular intrahepatic portosystemic shunt
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