EURORAD ESR

Case 15750

A difficult path taken: TIPS

Author(s)
Dr. Soumil Singhal, Dr. Bibin Sebastian, Dr. M.C. Uthappa, Dr. Rohit Madhurkar

BGS Gleaneagles Global, Intervention Radiology; Kengeri 560060 Bangalore, India; Email:drsoumilsinghal75@gmail.com
 
Patient
male, 70 year(s)
 
 
  • Figure 1
    Contrast Enhanced CT
     

    Axial sections shows features of chronic liver disease with filling defect within the portal vein

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;

    Filling defect seen extending into the right posterior division of portal vein

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;

    Filling defect seen in the main intrahepatic segment of portal vein

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 2
    Conventional Venography
     

    Right hepatic venogam

     
    Area of Interest: Interventional vascular; Imaging Technique: Conventional radiography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;

    Long sheath placed within right hepatic vein

     
    Area of Interest: Interventional vascular; Imaging Technique: Catheter venography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;

    Portal vein puncture showing poor filling

     
    Area of Interest: Interventional vascular; Imaging Technique: Catheter venography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;

    Difficulty in navigation of wire across the thrombosed portal vein

     
    Area of Interest: Interventional vascular; Imaging Technique: Conventional radiography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 3
    TIPS
     

    Use of micro-wire to navigate across the thrombus

     
    Area of Interest: Interventional vascular; Imaging Technique: Conventional radiography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;

    Use of coronary balloon for dilatation of tract for easily navigation of wire

     
    Area of Interest: Interventional vascular; Imaging Technique: Conventional radiography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;

    Tract dilatation prior to stent placement

     
    Area of Interest: Interventional vascular; Imaging Technique: Conventional radiography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;

    Pig tail run showing porto-hepatic shunt tract

     
    Area of Interest: Interventional vascular; Imaging Technique: Conventional radiography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;

    Stent placed across tract

     
    Area of Interest: Interventional vascular; Imaging Technique: Conventional radiography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;

    Flow across TIPSS stent

     
    Area of Interest: Interventional vascular; Imaging Technique: Conventional radiography; Procedure: Shunts; Special Focus: Haemodynamics / Flow dynamics;
     
     
Axial sections shows features of chronic liver disease with filling defect within the portal vein
 
Filling defect seen extending into the right posterior division of portal vein
 
Filling defect seen in the main intrahepatic segment of portal vein
 
Right hepatic venogam
 
Long sheath placed within right hepatic vein
 
Portal vein puncture showing poor filling
 
Difficulty in navigation of wire across the thrombosed portal vein
 
Use of micro-wire to navigate across the thrombus
 
Use of coronary balloon for dilatation of tract for easily navigation of wire
 
Tract dilatation prior to stent placement
 
Pig tail run showing porto-hepatic shunt tract
 
Stent placed across tract
 
Flow across TIPSS stent
 
 
 
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