Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance
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In brief
In brief
This study of 155 children with extrahepatic portal vein obstruction identified five distinct CT angiography patterns that correlate with etiology and bleeding risk. Neonatal sepsis was strongly associated with widespread thrombosis, while certain patterns predicted lower variceal bleeding risk, suggesting imaging can guide clinical management.
Written by the GCMD Library team from the article.
Abstract
Purpose
To study the relationship between the angiographic pattern of extrahepatic portal vein obstruction (EHPVO) and its etiology and clinical manifestations.
Methods
Clinical, etiological, and angiographic findings in 155 children with EHPVO were reviewed. Anatomy of extrahepatic portal venous system (EPVS) was categorized into five imaging patterns. Assessment of the severity of esophageal and gastric varices (EV and GV) was performed by upper gastrointestinal endoscopy.
Results
Based on multislice CT angiography, most commonly observed pattern of EHPVO was type I (48.4%) and type II (29%). According to anamnesis, 68 (43.8%) children had pathological conditions in neonatal period. Of these, 35 (22.6%) had an umbilical vein catheterization, 11 (7.1%) had a history of omphalitis, and 9 (5.8%) had prolonged jaundice. Thirteen (8.4%) patients had various septic conditions in neonatal period and it was more common associated with widespread thrombosis throughout the EPVS (type 5)—28% of observations. Significantly lower risk of bleeding from EV (p = 0.01) was noted in children with type IV pattern, whereas children with type III and V patterns had higher grades of EV.
Conclusion
Angiographic pattern of portomesenteric occlusion may provide a clue to its etiology, and clinical manifestation, especially in children with widespread thrombosis throughout the EPVS.