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Copyright ©2007 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 7, 2007; 13(13): 1912-1927
Published online Apr 7, 2007. doi: 10.3748/wjg.v13.i13.1912
Table 2 Radiological findings, treatment, and prognosis in VOD, BCS, and CH
VODBCSCH
Radiological findingsUltrasonography to rule out other liver disordersDoppler: Abnormal flow in a hepatic vein; large intrahepatic collateral vessels; e nlarged, stenotic, or tortuous hepatic veinsDilatation of all three hepatic veins on sonogram
Doppler may show reverse blood flow in the portal veinMRI: Large intrahepatic comma shaped c ollaterals. Hepatic venography: Spider web venous network patternECHO: Increased pulmonary artery pressure, dilatation of right side of heart, TR, abnormal diastolic ventricular filling due to pericardial disease
Treatment(1) Prevention: UDCA, heparin, LMWH, and defibrotide(1) Prevention of thrombus extension: Anticoagulation with heparin and warfarinTreatment of the underlying heart disease
(2) Treatment: Symptomatic care, defibrotide, tPA, AT-III concentrate(2) Restoration of blood flow: Thrombolytic therapy, percutaneous, angioplasty, TIPS, or shunt surgeryPericardiectomy in constrictive pericarditis
(3)TIPS and liver transplantation in selected cases(3) Liver transplantation
PrognosisMortality rate between 9% to 98% depending on the severityFive-year survival rate 42% to 89% in hepatic vein thrombosis and 25% in IVC obstructionLiver disease rarely contributes to mortality in these patients