We report the case of a 64-year-old female patient with an undifferentiated carcinoma involving the pancreatic head in whom hepatic metastasis and encasement of the portal and superior mesenteric veins had occurred. Ultrasound demonstrated a round well-defined hypoechoic mass with increased color Doppler flow signals at the periphery, while CT revealed a heterogeneously enhanced mass with a less attenuated central portion and rim enhancement of the pancreatic head.
Carcinoma* ; Female ; Head ; Humans ; Mesenteric Veins ; Middle Aged ; Neoplasm Metastasis ; Pancreas* ; Ultrasonography

Portal flow steal occasionally persists even after the liver transplantation, which may reduce the portal flow and thus threaten the patients' outcome. Therefore, pre- and peri-operative detection of portal steal phenomenon requiring radiological or surgical interruption is essential for the liver transplantation candidates as well as for the recipients.
Adult ; Hepatitis B, Chronic/complications ; Humans ; Liver Cirrhosis/etiology/*therapy ; *Liver Transplantation ; Male ; Mesenteric Veins/*ultrasonography

Nutcracker syndrome (NCS) is a syndrome caused by compression of the left renal vein (LRV), between the abdominal aorta and the superior mesenteric artery, resulting in hypertension of the LRV and hematuria. Doppler ultrasonography (US) has been commonly used for the diagnosis of NCS. However, several technical issues, such as Doppler angle and sample volume, need to be considered to obtain satisfactory results. In addition, morphologic changes of the LRV and a jetting phenomenon across the aortomesenteric portion of the LRV on contrast-enhanced computed tomography (CECT) are diagnostic clues of NCS. With proper Doppler US and CECT, NCS can be diagnosed noninvasively.
Aorta, Abdominal ; Diagnosis ; Hematuria ; Hypertension ; Mesenteric Artery, Superior ; Renal Veins ; Tomography, X-Ray Computed ; Ultrasonography, Doppler

Aneurysm of the portal venous system is extremely rare and its etiology is controversial. In the following study, a case congenital aneurysm of the portal vein is reported. A 47-year-old male had a one-year history of generalized weakness. During routine evaluation, an ultrasound examination showed a masslike dilatation of the portal vein near the porta hepatis and its distal portion was communicating with the normal-sized superior mesenteric vein. The diagnosis was confirmed by dynamic computed tomography and portal venography as portal vein aneurysm and an unusually tortuous portal vein. The patient had no history or clinical evidence of underlying liver disease, pancreatitis, or other disease states that would predispose development of an aneurysm. It was speculated that this portal vein aneurysm may have been congenital and that the associated tortuous portal vein may have been secondary to hemodynamic changes in the portal vein system.
Aneurysm* ; Diagnosis ; Dilatation ; Hemodynamics ; Humans ; Liver Diseases ; Male ; Mesenteric Veins ; Middle Aged ; Pancreatitis ; Phlebography ; Portal Vein* ; Ultrasonography

PURPOSE: Left renal vein entrapment syndrome has been suggested as an etiology for asymptomatic non-glomerular hematuria since it was reported as a cause of unilateral gross hematuria. Reported diagnostic criteria has been controversial since various degrees of left renal vein entrapment was found in normal children. Some of asymptomatic non-glomerular hematuria was not diagnosed even with renal biopsies but was usually known to have self-limited benign course. We analyzed the relationship between asymptomatic non-glomerular hematuria of unknown origin and the degree of left renal vein entrapment phenomenon. METHODS: The renal doppler sonograpy of 92 children with asymptomatic non-glomerular hematuria [gross hematuria(GH) N=44, microscopic hematuria (MH) N=48] were compared to 30 control children with normal renal function and urinalysis who underwent renal doppler sonography for abdominal pain and enuresis from January, 1999 to Febrary, 2000 at Ewha Womans Mokdong Hospital. The narrowed diameter(ND) of the left renal vein between the aorta and superior mesenteric artery and its maximal velocity(NV), and the dilated diameter(DD) of the left renal vein and its maximal velocity(DV) were measured and the DD/ND and NV/DV ratio were compared with those of the control children and the results of several previous reports. RESULTS: The DD/ND ratio was 3.9+/-1.89 in the GH group, 2.4+/-0.62 in the MH group, and 2.0+/-0.48 in the control group. There was a significant difference among GH, MH and control group(p<0.05). The NV/DV ratio was 3.6+/-2.37 in the GH group was significantly higher than 1.9+/-0.60 in the MH group and 1.7+/-0.55 in the control group(p<0.05). There was no significant differences between MH and control groups. Normal cut off values of DD/ND and NV/DV ratio in this study were 3.0 and 2.8 which was different to previous reports. CONCLUSION: Left renal vein entrapment phenomenon should be considered as one of the etiology of asymptomatic non-glomerular hematuria in children and the sonographic diagnostic criteria for Left renal vein entrapment syndrome needs to be revised.
Abdominal Pain ; Aorta ; Biopsy ; Child* ; Enuresis ; Female ; Hematuria* ; Humans ; Mesenteric Artery, Superior ; Renal Nutcracker Syndrome ; Renal Veins* ; Ultrasonography ; Urinalysis

PURPOSE: Left renal vein entrapment syndrome has been suggested as an etiology for asymptomatic non-glomerular hematuria since it was reported as a cause of unilateral gross hematuria. Reported diagnostic criteria has been controversial since various degrees of left renal vein entrapment was found in normal children. Some of asymptomatic non-glomerular hematuria was not diagnosed even with renal biopsies but was usually known to have self-limited benign course. We analyzed the relationship between asymptomatic non-glomerular hematuria of unknown origin and the degree of left renal vein entrapment phenomenon. METHODS: The renal doppler sonograpy of 92 children with asymptomatic non-glomerular hematuria [gross hematuria(GH) N=44, microscopic hematuria (MH) N=48] were compared to 30 control children with normal renal function and urinalysis who underwent renal doppler sonography for abdominal pain and enuresis from January, 1999 to Febrary, 2000 at Ewha Womans Mokdong Hospital. The narrowed diameter(ND) of the left renal vein between the aorta and superior mesenteric artery and its maximal velocity(NV), and the dilated diameter(DD) of the left renal vein and its maximal velocity(DV) were measured and the DD/ND and NV/DV ratio were compared with those of the control children and the results of several previous reports. RESULTS: The DD/ND ratio was 3.9+/-1.89 in the GH group, 2.4+/-0.62 in the MH group, and 2.0+/-0.48 in the control group. There was a significant difference among GH, MH and control group(p<0.05). The NV/DV ratio was 3.6+/-2.37 in the GH group was significantly higher than 1.9+/-0.60 in the MH group and 1.7+/-0.55 in the control group(p<0.05). There was no significant differences between MH and control groups. Normal cut off values of DD/ND and NV/DV ratio in this study were 3.0 and 2.8 which was different to previous reports. CONCLUSION: Left renal vein entrapment phenomenon should be considered as one of the etiology of asymptomatic non-glomerular hematuria in children and the sonographic diagnostic criteria for Left renal vein entrapment syndrome needs to be revised.
Abdominal Pain ; Aorta ; Biopsy ; Child* ; Enuresis ; Female ; Hematuria* ; Humans ; Mesenteric Artery, Superior ; Renal Nutcracker Syndrome ; Renal Veins* ; Ultrasonography ; Urinalysis

An association between nephrotic syndrome and thromboembolic phenomena has been known for many years. Most common sites of venous throm-bosis in nephrotic syndrome are al vein and deep vein of lower extremity. We report a case of minimal change nephrotic syndrome associated with unusual extensive venous thrombosis. A 29-year-old man was transferred to our hospital with severe abdominal pain and ascites. 2 months before admission, he was diagnosed as minimal change nephropathy at another hospital and treated with steroid therapy but he had persistent proteinuria on admission. The abdominal ultrasonography and CT scan revealed diffuse thrombosis of left renal vein, splenic vein, superior mesenteric vein and portal vein. Deep vein thrombosis of lower extremity was also found but not pulmonary embolism. There was no evidence of other primary hypercoagulable disease. He was treated with intravenous heparin immediately and three days later, abdominal pain disappeared. Prednisolone and cyclophosphamide were administered as well. After 1 month of therapy, proteinuria was resolved. Abdominal CT scan, taken after 2 months of therapy, revealed that diffuse thrombosis were almost resolved. From this case, diffuse abdominal thrombosis should be included as a diffrential diagnosis in a nephrotic patient with abdominal pain.
Abdominal Pain ; Adult ; Ascites ; Axis, Cervical Vertebra* ; Cyclophosphamide ; Diagnosis ; Heparin ; Humans ; Lower Extremity ; Mesenteric Veins ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Portal Vein ; Prednisolone ; Proteinuria ; Pulmonary Embolism ; Renal Veins ; Splenic Vein ; Thrombosis ; Tomography, X-Ray Computed ; Ultrasonography ; Veins ; Venous Thrombosis*

To evaluate of the relationship between basal ganglia lesion and portal-systemic encephalopathy, eleven patients who had clinically proved liver cirrhosis with superior mesenteric vein larger than 10mm in diameter on ultrasonogram underwent brain MR imaging. No evidence of clinical or neuropsychiatric disturbance was observed in any patient at the time of the MR examination. Brain MR imaging revealed basal ganglia lesion characterized by bilateral, symmetric, high signal intensity without edema or mass effect on spin echo T1-weighted images in nine patients which included three patients with the past history of portal-systemic encephalopathy. It was concluded that excepted in the circumstances of other causes of the high signal intensity in basal ganglia on T1-weighted images such as fat, methemoglobin, melanin, neurofibromatosis, dense calcification, and parenteral nutrition, bilateral and symmetric high signal intensity lesion, in basal ganglia would be a useful MR finding of subclinical portal-systemic encephalopathy in liver cirrhosis patients with no clinical or neuropsychiatric symptoms and larger than 10mm diameter of superior mesenteric vein in ultrasonography.
Basal Ganglia* ; Brain ; Edema ; Hepatic Encephalopathy* ; Humans ; Liver Cirrhosis* ; Liver* ; Magnetic Resonance Imaging* ; Melanins ; Mesenteric Veins ; Methemoglobin ; Neurofibromatoses ; Parenteral Nutrition ; Ultrasonography

Acute thrombosis of the portal and superior mesenteric vein (SMV) due to inflammation of abdominal organs is a rare condition, but delayed diagnosis causes severe problems and serious long term complications. Therefore the early diagnosis and adequate management of the underlying disease and thrombus is very important. Here a case of an 84-year-old man with portal vein and SMV thrombosis on Doppler ultrasonography and computed tomography (CT) after cholecystectomy and choledochostomy by the 10th day is reported. The patient's condition improved without complication after the treatments with an anticoagulant regimen and antimicrobials. In the follow up, there was no thrombus on the CT or sign of a recurrent disease.
Aged, 80 and over ; Cholangitis ; Cholecystectomy* ; Choledochostomy* ; Delayed Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Humans ; Inflammation ; Mesenteric Veins* ; Portal Vein* ; Thrombosis* ; Ultrasonography, Doppler ; Venous Thrombosis

Multiple bilobar liver metastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). At first, a laparoscopy-assisted anterior resection was performed. We performed the 1st stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion balloon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1st hepatectomy. A right hepatectomy was safely performed 22 days after the 1st hepatectomy. The patient had received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 6 months, then has been receiving a systemic chemotherapy (biweekly Oxaliplatin, leucovorin, plus 5-fluorouracil) without any recurrence evidence.
Catheters ; Colon* ; Colonic Neoplasms* ; Drug Therapy ; Hepatectomy ; Humans ; Leucovorin ; Liver* ; Mesenteric Veins ; Middle Aged ; Neoplasm Metastasis* ; Portal Vein ; Recurrence ; Sigmoid Neoplasms ; Ultrasonography