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2017, Number 3

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Anales de Radiología México 2017; 16 (3)

Cavernous transformation of the portal vein as a cause of portal hypertension. Report on two clinical cases

Motta-Ramírez GA

Language: Spanish
References: 34
Page: 227-226
PDF size: 1023.50 Kb.


ABSTRACT

Purpose: recognize the CT angiography protocol as the initial diagnostic method for pulmonary thromboembolism. Correlate the clinical data which raised suspicion and indication for the study and increase the accuracy of diagnosis.
Material and Methods: in a first group, 145 studies/128 patients were reviewed over 3 years (June 2003 through June 2006) with multidetector tomography (16) and CT angiography protocol due to suspicion of pulmonary thromboembolism. Interpretations of the studies, both retrospective and prospective, were provided by two physicians. Requests submitted were examined to identify clinical data which raised suspicion, signaling of Wells criteria or any other criterion establishing the probability of pulmonary thromboembolism; we analyzed whether it was acute/chronic, central/ peripheral, unilateral/bilateral, associated with pulmonary infarct or not, association with pleural/pericardial effusion and whether it was associated with oncological disorders or other predisposing factors. In a second group, 110 multidetector tomographies (8 and 16) with CT angiography protocol were reviewed due to suspicion of pulmonary thromboembolism/venography by tomography, in 98 patients, from April 2005 to January 2010, including patients who were asked to submit to the protocol and those in whom, incidentally, without prior clinical suspicion, pulmonary thromboembolism was identified; we also reviewed the clinical conditions which gave rise to suspicion, use of the Wells criteria, and the D-dimer test and analyzed if it was acute/chronic, central/peripheral, and unilateral/bilateral and if it was associated with oncological disorders or other predisposing factors.
Results: in the first group, 15 studies/14 patients were excluded, giving a final total of 130 studies/114 patients. In 81 studies, 78 patients, results were negative for pulmonary thromboembolism (68.42%). In 49 studies, 36 patients were positive for pulmonary thromboembolism (31.57%). In 11 patients, pulmonary thromboembolism was classified as acute, in 7 as chronic and in 15 as acute chronic. In 7 positive patients, subsequent studies showed persistence and in 5 resolution. In 49 studies, 36 patients were positive for pulmonary thromboembolism (31.57%). In the second group, of the 110 studies included, 58 were positive (53%) and 52 negative (47%). Of the studies with positive results the diagnosis was incidental in 15 (26%). Clinical association of primary oncological pathology was identified and CT angiography to detect pulmonary thromboembolism was indicated in 9 cases (8% of the studies). In 12 (11%) of cases, we identified clinical association with a recent surgical event, respiratory difficulty, and indication of CT angiography to detect pulmonary thromboembolism.
Conclusion: pulmonary CT angiography is helpful in identification and characterization of pulmonary thromboembolism and is the study of choice with 100% sensiti vity and specificity.


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