Portosystemic collateral pathways

Last revised by Dr Yuranga Weerakkody ◉ on 12 Jan 2022

Citation, DOI and article data

Citation:

D'Souza, D., Weerakkody, Y. Portosystemic collateral pathways. Reference article, Radiopaedia.org. (accessed on 23 Jan 2022) https://doi.org/10.53347/rID-1910

DOI:

https://doi.org/10.53347/rID-1910

Permalink:

https://radiopaedia.org/articles/1910

rID:

1910

Article created:

02 May 2008 by Associate Professor Donna D'Souza ◉

Revisions:

35 times by 12 users - see full revision history

System:

Vascular, Gastrointestinal, Hepatobiliary

Section:

Anatomy

Tag:

varices

Synonyms:

Varices (portosystemic shunts)
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

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:

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 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.