Diagnostic Ultrasound - Abdomen and Pelvis

Venoocclusive Disease
Diagnoses: Liver
TERMINOLOGY
• Hepatic venous outflow obstruction due to occlusion of
terminal hepatic venules and sinusoids
• Synonym: Hepatic sinusoidal obstruction syndrome
IMAGING
• Hepatosplenomegaly, ascites, gallbladder wall thickening
• Narrowing of hepatic veins
• Color Doppler ultrasound
○ Elevated hepatic arterial velocity > 100 cm/s
○ Slow portal venous velocity (< 10 cm/s) or hepatofugal
flow
TOP DIFFERENTIAL DIAGNOSES
• Graft-vs.-host disease
• Budd-Chiari syndrome
• Portal vein thrombosis
• Portal hypertension
• Opportunistic infection
KEY FACTS
PATHOLOGY
• Injury to hepatic venous endothelium
• Progresses to deposition of fibrinogen + factor VIII within
venule and sinusoidal walls
• Progressive venular obstruction, centrilobular hemorrhagic
necrosis
• Sclerosis of venular wall and intense collagen deposition in
sinusoids and venules
CLINICAL ISSUES
• Occurs most frequently following hematopoietic cell
transplantation
○ Responsible for 5-15% of deaths in population with VOD
• Signs and symptoms of liver failure with painful
hepatomegaly, jaundice, peripheral edema, unexplained
weight gain
• Clinical and laboratory features of VOD usually begin within
3 weeks of transplantation
(Left) Color Doppler US of the
liver shows hepatofugal flow
in the main portal vein ſt in a
patient with venoocclusive
disease (VOD) after bone
marrow transplant for AML.
Note edematous appearance
of the liver and hypertrophied
hepatic artery . (Right) On
pulsed Doppler US in the same
patient, peak systolic velocity
measured at the common
hepatic artery is elevated to
168 cm/s, confirming high
flow state of the hepatic
artery related to hepatic
arterial buffer response to
hepatofugal portal flow.
(Left) Grayscale ultrasound of
liver shows markedly
edematous and an enlarged
liver resulting in narrowed
hepatic veins st and smallcaliber
inferior vena cava ſt in
this patient with VOD. A small
right pleural effusion is
also evident. (Right) Grayscale
ultrasound shows diffuse
gallbladder wall thickening ſt
and sludge in this patient
with VOD. Gallbladder wall
thickening in isolation is a
nonspecific finding. However,
in combination with other
sonographic findings of VOD,
is supportive of this diagnosis.
192
http://radiologyebook.com/