EURORAD ESR

Case 13587

US confirmation of hepatopetal flow through bladder-umbilical-portal pathway in a patient affected by inferior vena cava obstruction due to retroperitoneal fibrosis and pelvic lipomatosis

Author(s)
Francesca Rosa, Luca Basso, Marta Baglietto, Lucia Secondini, Valentina Prono, Migone Stefania, Carlo Emanuele Neumaier

IRCSS A.O.U. "San Martino"
ST, Scuola di Specializzazione in Radiodiagnostica;
Via L.B. Alberti,
4 Genova, Italy;
Email:lucyeah@hotmail.it
 
Patient
male, 56 year(s)
 
 
  • Figure 1
    Retroperitoneal fibrosis, benign features
     

    CTI (a/b) and T2WI MRI (c) visualize soft tissue which spares the great vessels, is mainly located distal to the renal hilum and has an infiltrative aspect enveloping rather than displacing adjacent structures.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Tissue characterisation;

    CTI (a/b) and T2WI MRI (c) visualize soft tissue which spares the great vessels, is mainly located distal to the renal hilum and has an infiltrative aspect enveloping rather than displacing adjacent structures.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Tissue characterisation;

    MRI shows low T2 signal intensity reflecting poor or absent inflammation activity due to glucocorticosteroid therapy.

     
    Area of Interest: Abdomen; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;
     
     
  • Figure 2
    Bladder-umbilical-portal pathway
     

    A vein, originating from the ectasic perivescical venous plexus, was directed to the umbilicus following the way of the urachus. This vein and the recanalyzed paraumbilical veins created a collateral pathway from...

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Computer Applications-3D; Special Focus: Haemodynamics / Flow dynamics;

    A vein, originating from the ectasic perivescical venous plexus, was directed to the umbilicus following the way of the urachus. This vein and the recanalyzed paraumbilical veins created a collateral pathway from...

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Computer Applications-3D; Special Focus: Haemodynamics / Flow dynamics;

    Patent umbilical vein (yellow arrow).

     
    Area of Interest: Anatomy; Imaging Technique: CT; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Haemodynamics / Flow dynamics;

    Vein, shown in the figure (yellow arrow) originating from ectasic perivescical venous plexus and directed to the umbilicus.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 3
    Pelvic lipomatosis features:
     

    T1WI) diagnostic criteria: elongation and elevation of urinary bladder with symmetrical inverted pear-shaped morphology (yellow arrows).

     
    Area of Interest: Abdomen; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    T1WI fat suppressed. Diagnostic criteria: elongation and narrowing of the rectum,elevation of rectosigmoid and sigmoid colon out of pelvis, increase in sacro-rectal space > 10 mm (in our patient 45 mm, red line).

     
    Area of Interest: Abdomen; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;
     
     
  • Figure 4
    Third inflow and hepatopetal flow
     

    MDCT shows hypodense area during portal phase due to hepatopetal flow (“third inflow”) through superior Sappey vein.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Tissue characterisation;

    Colour Doppler confirms our suspicion: two venous flows, one portal and one through patent venosus duct, have different directions.

     
    Area of Interest: Vascular; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Education; Special Focus: Haemodynamics / Flow dynamics;

    Further, C- D, pulsed Doppler confirms that the two flows analysed are venous.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: Ultrasound-Power Doppler; Procedure: Education; Special Focus: Haemodynamics / Flow dynamics;

    Further, C- D, pulsed Doppler confirms that the two flows analysed are venous.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: Ultrasound-Power Doppler; Procedure: Education; Special Focus: Haemodynamics / Flow dynamics;
     
     
CTI (a/b) and T2WI MRI (c) visualize soft tissue which spares the great vessels, is mainly located distal to the renal hilum and has an infiltrative aspect enveloping rather than displacing adjacent structures.
 
CTI (a/b) and T2WI MRI (c) visualize soft tissue which spares the great vessels, is mainly located distal to the renal hilum and has an infiltrative aspect enveloping rather than displacing adjacent structures.
 
MRI shows low T2 signal intensity reflecting poor or absent inflammation activity due to glucocorticosteroid therapy.
 
A vein, originating from the ectasic perivescical venous plexus, was directed to the umbilicus following the way of the urachus. This vein and the recanalyzed paraumbilical veins created a collateral pathway from bladder to liver.
 
A vein, originating from the ectasic perivescical venous plexus, was directed to the umbilicus following the way of the urachus. This vein and the recanalyzed paraumbilical veins created a collateral pathway from bladder to liver.
 
Patent umbilical vein (yellow arrow).
 
Vein, shown in the figure (yellow arrow) originating from ectasic perivescical venous plexus and directed to the umbilicus.
 
T1WI) diagnostic criteria: elongation and elevation of urinary bladder with symmetrical inverted pear-shaped morphology (yellow arrows).
 
T1WI fat suppressed. Diagnostic criteria: elongation and narrowing of the rectum,elevation of rectosigmoid and sigmoid colon out of pelvis, increase in sacro-rectal space > 10 mm (in our patient 45 mm, red line).
 
MDCT shows hypodense area during portal phase due to hepatopetal flow (“third inflow”) through superior Sappey vein.
 
Colour Doppler confirms our suspicion: two venous flows, one portal and one through patent venosus duct, have different directions.
 
Further, C- D, pulsed Doppler confirms that the two flows analysed are venous.
 
Further, C- D, pulsed Doppler confirms that the two flows analysed are venous.
 
 
 
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