Portosystemic collateral pathways

Last revised by Dr Yuranga Weerakkody on 12 Jan 2022

Portosystemic collateral pathways (also called 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:

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.

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Cases and figures

  • Case 1: recanalized paraumbilical vein
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  • Case 2: SMV varices
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  • Case 3: gastro-esophageal varices
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  • Case 4: many sites
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