Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

World J Gastroenterol. 2017 Mar 14;23(10):1735-1746. doi: 10.3748/wjg.v23.i10.1735.

Abstract

Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

Keywords: Diagnostic imaging; Image-guided therapy; Portal hypertension; Portosystemic collaterals.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Collateral Circulation*
  • Endoscopy
  • Hemodynamics
  • Humans
  • Hypertension, Portal / diagnostic imaging*
  • Hypertension, Portal / surgery*
  • Liver / blood supply
  • Liver / diagnostic imaging
  • Liver Diseases / complications*
  • Liver Diseases / diagnostic imaging
  • Magnetic Resonance Imaging / methods
  • Portal Pressure
  • Portal System / anatomy & histology
  • Portal System / diagnostic imaging*
  • Portasystemic Shunt, Transjugular Intrahepatic / methods
  • Surgery, Computer-Assisted
  • Tomography, X-Ray Computed / methods
  • Ultrasonography / methods