A 69 years old female patient presented to our Radiology department to control a hepatic cyst that have been drained because of its great dimensions

Belo-Oliveira, P

Belo-Soares, P

Martins, M

Pinto, E

Vaz, O

English

Name not available

Hepatic arterioportal fistula: Doppler and Ultrasound findings

CHUC Institutional Repository

Repositório Institucional dos Hospitais da Universidade de Coimbra

 HYPERLINK "http://www.eurorad.org/eurorad/index.php" Hepatic arterioportal fistula – Doppler and Ultrasound findingsAuthor(s)Belo-Oliveira P, Vaz O, Belo-Soares P, Martins M, Pinto E  Patientfemale, 69 year(s) Clinical Summary A 69 years old female patient presented to our Radiology department to control a hepatic cyst that have been drained because of its great dimensions. Clinical History and Imaging Procedures A 69 years old female patient presented to our Radiology department to control a hepatic cyst that have been drained because of its great dimensions. Ultrasound confirmed the presence of the cyst at the left hepatic lobe, with a small size. However we could see a small hypoechoic nodule nearby. Colour Doppler ultrasound demonstrated the highly vascular nature of the nodule. Pulsed Doppler ultrasound of the enlarged hepatic artery demonstrated high-velocity flow and a low resistivity index, and colour speckling in the hepatic parenchyma adjacent to the nodule. Contrast enhanced ultrasound confirmed the highly vascular nature of the nodule establishing the diagnosis of a hepatic arterioportal fistula. Discussion Arterioportal fistulas may be intra- or extrahepatic and acquired or congenital. The most common causes of acquired arterioportal fistulas are cirrhosis and hepatic neoplasms, blunt or penetrating trauma, percutaneous liver biopsy, transhepatic cholangiography, gastrectomy, and biliary surgery. They can be associated with hereditary hemorrhagic telangiectasia, Ehlers-Danlos syndrome, and biliary atresia, although in most case reports they are not associated with any other disease. Arteriovenous fistula is a known complication of percutaneous liver biopsy. Most are arterial—portal fistulas, which are believed to occur more frequently than hepatic arteriovenous fistulas because of the closer proximity in the liver of the hepatic artery to the portal vein. Doppler US is the single most useful imaging modality for making the diagnosis. Common findings include enlargement of the hepatic artery and dilatation of the segment of the portal vein where the fistula is located. Doppler US features of arterioportal fistula include pulsatile hepatofugal flow in the portal vein and colour speckling in the hepatic parenchyma adjacent to the fistula (vibration artefact). Both contrast-enhanced CT and contrast-enhanced MR imaging may demonstrate marked enhancement of the main portal vein, segmental branches, or major tributaries, with attenuation or signal intensity approaching that of the aorta on arterial-phase images. Perfusion anomalies of the adjacent parenchyma can also be demonstrated (eg, regional increase in arterial inflow as a response to the inverted portal flow, increase in portal vein inflow due to the shunt itself). If left untreated, arterialization of the portal vein causes early onset of portal hypertension. Hepatoportal sclerosis and fibrosis of the portal radicles subsequently develop, further contributing to portal hypertension. Congenital hepatic arterioportal fistula in infants with biliary atresia is difficult to resolve because these infants are abnormally dependent on arterial inflow, and ligation or embolization of the hepatic artery could lead to fatal hepatic necrosis. Embolization of the feeding artery with or without subsequent surgery is currently the preferred therapeutic option. It is important to closely observe affected patients because the fistula can recur through arterial collateralization. If the symptoms cannot be controlled with therapeutic manoeuvres, liver transplantation is the only remaining option. Final Diagnosis Hepatic arterioportal fistula – Doppler and Ultrasound findings  MeSH1.	Arteriovenous Fistula [C14.907.150.125] An abnormal communication between an artery and a vein. References1.	[1]Arterioportal fistula causing acute pancreatitis and hemobilia after liver biopsy. Machicao VI, Lukens FJ, Lange SM, Scolapio JS. J Clin Gastroenterol. 2002 Apr;34(4):481-4 (​http:​/​​/​www.ncbi.nlm.nih.gov​/​entrez​/​query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11907368" \t "_blank​) 2.	[2]Arterioportal fistula and hemobilia with associated acute cholecystitis: a complication of percutaneous liver biopsy. Cacho G, Abreu L, Calleja JL, Prados E, Albillos A, Chantar C, Perez Picouto JL, Escartin P. Hepatogastroenterology. 1996 Jul-Aug;43(10):1020-3 (​http:​/​​/​www.ncbi.nlm.nih.gov​/​entrez​/​query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8884332" \t "_blank​) 3.	[3]Coil embolization of a solitary congenital intrahepatic hepatoportal fistula. Raghuram L, Korah IP, Jaya V, Athyal RP, Thomas A, Thomas G. Abdom Imaging. 2001 Mar-Apr;26(2):194-6 (​http:​/​​/​www.ncbi.nlm.nih.gov​/​entrez​/​query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11178699" \t "_blank​) CitationBelo-Oliveira P, Vaz O, Belo-Soares P, Martins M, Pinto E (2005, Nov 22).Hepatic arterioportal fistula – Doppler and Ultrasound findings, {Online}.URL: http://www.eurorad.org/case.php?id=3859DOI: 10.1594/EURORAD/CASE.3859 (​http:​/​​/​dx.doi.org​/​10.1594​/​EURORAD​/​CASE.3859​) HYPERLINK "javascript:void(0)" To top  	Published 22.11.2005 	DOI 10.1594/EURORAD/CASE.3859 	Section Liver, Biliary System, Pancreas, Spleen (​javascript:search_section(10)​) 	Case-Type Clinical Case (​javascript:search_type(5)​) 	Views 38 	Language(s) 	Figure 1 Abdominal ultrasoundAbdominal ultrasound showing the hepatic cyst 	Figure 2 Abdominal ultrasoundAbdominal ultrasound showing the hypoechoic nodule 	Figure 3 Abdominal ultrasoundAbdominal ultrasound showing the hypoechoic nodule 	Figure 4 Colour Doppler ultrasoundColour Doppler ultrasound demonstrated the highly vascular nature of the nodule.  	Figure 5 Colour Doppler ultrasoundColour Doppler ultrasound demonstrated the highly vascular nature of the nodule.  	Figure 6 Pulsed Doppler ultrasoundPulsed Doppler of the enlarged hepatic artery demonstrated high-velocity flow and a low resistivity index 	Figure 7 Pulsed Doppler ultrasoundPulsed Doppler of the enlarged hepatic artery demonstrated high-velocity flow and a low resistivity index 	Figure 8 Contrast enhanced ultrasoundarterial phase contrast enhanced ultrasound confirmed the highly vascular nature of the nodule 	Figure 9 Contrast enhanced ultrasoundportal phase contrast enhanced ultrasound confirmed the highly vascular nature of the nodule 	Figure 10 Contrast enhanced ultrasoundlate phase contrast enhanced ultrasound confirmed the vascular nature of the nodule 	Figure 11 Contrast enhanced ultrasoundcontrast enhanced ultrasound confirming the presence of the cyst Figure 1 Abdominal ultrasoundAbdominal ultrasound showing the hepatic cyst Figure 2 Abdominal ultrasoundAbdominal ultrasound showing the hypoechoic nodule Figure 3 Abdominal ultrasoundAbdominal ultrasound showing the hypoechoic nodule Figure 4 Colour Doppler ultrasoundColour Doppler ultrasound demonstrated the highly vascular nature of the nodule.  Figure 5 Colour Doppler ultrasoundColour Doppler ultrasound demonstrated the highly vascular nature of the nodule.  Figure 6 Pulsed Doppler ultrasoundPulsed Doppler of the enlarged hepatic artery demonstrated high-velocity flow and a low resistivity index Figure 7 Pulsed Doppler ultrasoundPulsed Doppler of the enlarged hepatic artery demonstrated high-velocity flow and a low resistivity index Figure 8 Contrast enhanced ultrasoundarterial phase contrast enhanced ultrasound confirmed the highly vascular nature of the nodule Figure 9 Contrast enhanced ultrasoundportal phase contrast enhanced ultrasound confirmed the highly vascular nature of the nodule Figure 10 Contrast enhanced ultrasoundlate phase contrast enhanced ultrasound confirmed the vascular nature of the nodule Figure 11 Contrast enhanced ultrasoundcontrast enhanced ultrasound confirming the presence of the cyst To top (​javascript:void(0)​)   Home (​http:​/​​/​www.eurorad.org​/​eurorad​/​index.php​) Search (​http:​/​​/​www.eurorad.org​/​eurorad​/​search.php​) History (​http:​/​​/​www.eurorad.org​/​eurorad​/​history.php​) FAQ (​http:​/​​/​www.eurorad.org​/​eurorad​/​faq.php​) Contact (​http:​/​​/​www.eurorad.org​/​eurorad​/​contact.php​) Disclaimer (​http:​/​​/​www.eurorad.org​/​eurorad​/​disclaimer.php​) Imprint (​http:​/​​/​www.eurorad.org​/​eurorad​/​imprint.php​) 

http://rihuc.huc.min-saude.pt/bitstream/10400.4/48/1/Hepatic%20arterioportal%20fistula.doc

Hepatic arterioportal fistula: Doppler and Ultrasound findings

Abstract

Similar works

Full text

Available Versions

Name not available

CHUC Institutional Repository

Repositório Institucional dos Hospitais da Universidade de Coimbra