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World J Gastroenterol. Sep 14, 2008; 14(34): 5331-5335
Published online Sep 14, 2008. doi: 10.3748/wjg.14.5331
Characteristics of paraesophageal varices: A study with 64-row multidetector computed tomography portal venography
Li-Qin Zhao, Wen He, Guang Chen
Li-Qin Zhao, Wen He, Guang Chen, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: He W and Zhao LQ designed the research; Zhao LQ, Chen G performed the data collection; Zhao LQ and He W performed the post-processing of the images and analyzed data; Zhao LQ wrote the manuscript; He W revised the paper.
Supported by The Science Technology Program of Beijing Education Committee, No. KM200810025002
Correspondence to: Wen He, MD, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong’An Road, Xuan Wu District, Beijing 100050, China. hewen1724@sina.com
Telephone: + 86-10-63138470 Fax: + 86-10-63134411
Received: June 19, 2008
Revised: July 27, 2008
Accepted: August 3, 2008
Published online: September 14, 2008
Abstract

AIM: To identify the characteristics of morphology, location and collateral circulation involved in paraesophageal varices (para-EV) of portal hypertension patients with 64-row multidetector computed tomography (MDCT).

METHODS: Fifty-two of 501 patients with portal hypertensive cirrhosis accompanied with esophageal varices were selected for 64-row MDCT examination after the observation of para-EV. The CT protocol included unenhanced, arterial and portal phases with a slice thickness of 0.625 mm and a scanning field of 2 cm above the bifurcation to the lower edge of kidney. The CT portal venography (CTPV) was reformatted on AW4.3 workstation. The characteristics of origination, location, morphology and collateral circulation in para-EV were observed.

RESULTS: Among the 52 cases of para-EV, 50 showed the originations from the posterior branch of left gastric vein, while the others from the anterior branch. Fifty cases demonstrated their locations close to the esophageal-gastric junction, and the other two cases were extended to the inferior bifurcation of the trachea. The circuitous pattern was observed in 16 cases, while reticulated pattern was seen in 36 cases. Collateral circulation identified 4 cases of single periesophageal varices (peri-EV) communication, 3 cases of single hemiazygous vein, one case of single inferior vena cava, 41 cases of mixed type (collateral communications of at least 2 of above mentioned types) and 3 cases of undetermined communications. Among all the cases, 43 patients showed the communications between para-EV and peri-EV, while hemiazygous vein (43 cases) and inferior vena cava (5 cases) were also involved.

CONCLUSION: Sixty-four-row multidetector computed tomography portal venography could display the location, morphology, origin, and collateral types of para-EV, which provides important and referable information for clinical management and disease prognosis.

Keywords: Computer tomography; Portal venography; Paraesophageal varices; Hepatic cirrhosis; Portal hypertension