0:01

The following are two different patients with

0:03

cirrhosis, both of whom have imaging features

0:06

of portal hypertension, which is what we're

0:09

going to showcase in this video vignette.

0:11

So as we scroll through these

0:12

images, both of which are T2-weighted

0:16

sequences performed without fat

0:18

saturation in two different patients.

0:20

In this patient, you can see that

0:22

there's a lot of ascitic fluid.

0:25

And so patients with portal hypertension

0:27

will often see varying amounts of ascites, so

0:30

that's one of the features that you should look

0:32

for, and one of the features that you should

0:34

comment on, whether it's a small amount, a

0:36

moderate amount, or a large amount of ascites.

0:39

We can see more ascites over here and

0:41

over here in the left upper quadrant.

0:43

In this other patient over here,

0:44

we can see other features of portal

0:46

hypertension, namely splenomegaly.

0:49

Splenomegaly.

0:50

It's measured typically in the cranial

0:52

caudate dimension, so I like using

0:54

coronal sequences to measure it.

0:56

And anything above 13 centimeters is

0:59

generally considered too big for the spleen.

1:03

Another feature that can be seen with the

1:05

spleen is the presence of gammaglobulins.

1:08

And this is nicely demonstrated

1:10

in this patient over here.

1:12

This is a T1-weighted sequence

1:14

performed out of phase, no contrast.

1:18

This is a T1-weighted sequence.

1:20

Performed in phase, no intravenous contrast.

1:23

And if we look at the spleen, we can see

1:26

that there are multiple tiny splenic nodules.

1:29

For example, we'll showcase this one over here.

1:31

In the out-of-phase image, it looks pretty dark.

1:33

And on the in-phase image, it looks larger.

1:36

Now the size itself is not changing, but it's

1:39

demonstrating a blooming artifact that can be

1:42

seen with what we call gammaglobulin bodies.

1:48

These are little siderotic nodules, little

1:51

iron-containing nodules essentially that

1:53

can be seen in the spleen, um, particularly

1:56

in the setting of portal hypertension.

1:58

Another feature to look for in patients with

2:01

cirrhosis, and you're looking for signs of

2:03

portal hypertension, is the presence of varices.

2:06

So this is a T1-weighted sequence

2:09

performed with intravenous contrast,

2:12

done in the portal venous phase.

2:13

And you can see surrounding the esophagus

2:16

over here that there are multiple

2:17

serpiginous enhancing structures.

2:20

These are all going to be varices,

2:22

parasophageal varices in this patient who has

2:25

cirrhosis and signs of portal hypertension.

2:28

And yet another place that you're going

2:30

to look for signs of portal hypertension is

2:33

typically in that intersegmental fissure.

2:35

With portal hypertension, you can get

2:37

a recanalized paraumbilical vein.

2:43

So this is just a version of

2:45

a portosystemic shunt that develops

2:49

because of the portal hypertension; blood

2:51

gets siphoned through this collateral

2:53

vessel, goes into the anterior abdominal

2:55

wall, and drains into the systemic

2:58

vasculature before going back to the heart.